Transcript Chapter 11

CHAPTER
11
ALLERGY AND RESPIRATORY
MEDICATIONS
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Learning Objectives
 Identify major antihistamines used to treat breathing
problems
 Describe the action of antitussive medications
 List medications used to treat and prevent asthma attacks
 Describe the major actions and the adverse reactions of the
two main categories of bronchodilators
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Types of AntiHistamines
 ALKYLAMINES
 bromopheniramine
(Dimetapp)
 chlorpheniramine
(Chlo-Trimeton)
 ETHANOLAMINES
 diphenhydramine
(Benadryl)
 PHENOTHIAZINE
 promethazine
(Phenergan)
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
 PIPERIDINES
 cetirizine (Zyrtec)
 fexofenadine (Allegra)
 lorantidine (Claritin)
 PIPERAZINE
 hydroxyzine (Vistaril)
 MISCELLANEOUS
 azelastine (Astelin)
Antihistamines (cont.)
 Uses
 Seasonal allergic rhinitis (SAR)
 Perennial allergic rhinitis (PAR)
 Perennial nonallergic rhinitis (PNAR)
 Relieve symptoms of allergic disorders
 Adjunctive therapy for anaphylaxis
 Sedation
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antihistamines
 Action
 Compete with histamine for H1 receptor sites to limit its
effectiveness
 Limits vasodilation, capillary permeability, and swelling
 Limits acetylcholine release, which dries secretions in the
bronchioles and gastrointestinal system
 Sedative effect on the CNS
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antihistamines (cont.)
 Adverse Reactions
 Changes in blood pressure, blurred vision
 Tachycardia, insomnia, dry mouth, nausea
 Restlessness, excitability, sedation, tinnitus
 Drug Interactions
 Nursing Process
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antihistamines
Life span considerations
 Pediatrics:
 Infants and young children often have anticholinergic side/adverse
effects
 Paradoxical reactions may occur: increased nervousness, confusion, or
hyperexcitability
 Elderly
 More likely to develop side effects such as dizziness, syncope (fainting),
confusion, and extrapyramidal reactions
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Question 1
Which of the following is NOT an adverse reaction that
may develop from taking antihistamines?
1. Hypertension
2. Hypotension
3. Tachycardia
4. Bradycardia
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Types of Antitussives
 Narcotic
 codeine phosphate
 codeine sulfate
 Non-Narcotic
 dextromethorphan
 Robitussin
 Vick’s Formula 44
 diphenhydramine
 Benadryl
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antitussives
 Actions:
 Depress the cough center in the brain
 Anesthetize stretch receptors in the respiratory tract
 Soothe irritated areas in the throat
 Uses:
 Relief of overactive or nonproductive cough
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Antitussives (cont.)
 Adverse Reactions
 Constipation, drowsiness, dry mouth, nausea, postural
hypotension
 Drug Interactions
 Nursing Process
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
ASTHMA PREVENTION
 INTAL (cromolyn sodium)
 Action: slows destruction of mast cell which releases the
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histamine resulting in decreased histamine circulation
ONLY for prophylaxis
NOT A RESCUE MEDICATION
Must be inhaled on a set schedule
Symptoms improve within 4 weeks
See MD at weeks 2 & 4
Do not stop drug abruptly
Types of Asthma Bronchodilators
 Sympathomimetic
(Rescue Drugs)
 Proventil / Ventolin
 (albuterol***)
 Adrenalin Chloride
 (epinephrine)
 Isuprel
 (isoproterenol)
 Alupent
 (metaproterenol)
 Serevent (salmeterol)
 Brethine (terbutaline)
 Xanthine (-phylline)
 Aminophylline
 Slo-Phyllin
 (theophylline)
*** albuterol has less cardiac
side effects & longer bronchodilation
than remainder of drugs listed
Action of Bronchodilators
 Open the airway by stimulating Beta 2 receptors
 Some drugs have greater effects on Beta 1 (heart) than others
 Sympathomimetic drugs mimic epinephrine stimulation as
side effects
 Tachycardia and insomnia are frequently seen.
Additional Asthma meds
 Leukotriene receptor inhibitors (for chronic use); decreases
the interleukine release from the injured tissues. NOT a
rescue medication
 Singulair
(montelukast)
 Accolate
(zafirlukast)
Corticosteroid Use for Asthma/ COPD
 Systemic
 methylprednisolone
 Inhaled
 prednisolone
 Beclovent
 (beclomethasone)
 prednisone
 Pulmicort (cortisone for
pulmonary tract)
 (budesonide)
 Aerobid (flunisolide)
 Flovent (fluticasone
propionate)
 Azmacort (triamcinolone
acetonide)
Intranasal Steroids (Sprays)
 Beconase (beclomethasone dipropionate)
 Rhinocort Aqua (Budesonide)
 Aerobid (flunisolide)
 Flonase (fluticasone propionate)
 Nasonex (mometasone furoate)
 Nasocort AQ (triamcinolone acetonide)
 Many are the same as inhaler medications but reformulated
for spray application
 Effects are topical unless swallowed
Actions of Corticosteroid Usage
 ‘… the most potent and consistently effective medication for
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long term control of asthma.”
Anti-inflammatory; decrease reaction to allergens
Systemic steroids are used to get quick control of the airway
then inhaled steroids will be used to maintain the effect.
Inhaled drugs have a local effect; better for long term use
RINSE the mouth after steroid inhalation to prevent thrush
 Remember: COME -TAPE- FIGS
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C = Cataracts
O = Osteoporosis
M = Mood changes
E = Elevated blood sugar
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T = Thin skin
A = Addison’s disease
P = Peptic ulcers
E = Electrolyte imbalance
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F = Fluid retention
I = Increased risk of infection
G = Gain Weight
S = Short stature (if taken as a child)
Decongestants
 Affect alpha cells in blood vessels in nose tissue =
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vasoconstriction, decreased fluid movement and edema.
Prolonged use can lead to rebound vasodilation causing more
congestion.
Used for congestion in nose, middle ear and Eustachian tube.
Decreasing congestion around the auditory tube allows the
middle ear to better drain
NOT to be used in infants and toddlers
Systemic decongestants work better than topical but also
have more side effects than topical drugs.
Nasal Decongestants
 Sympathomimetic
bronchodilators
 ephdrine
 Epinephrine *
 Inhalers
 Afrin / Dristan
 (oxymetazoline)
 Neo-Synephrine
 (phenylephrine)
 Sudafed
 (pseudoephedrine sulfate)
* denotes drug used by MDs
on a daily basis
Expectorants
 Decrease the thickness of the mucus (by increasing the water
content) in the respiratory tract to aid in the ability to
remove it. Increases ciliary movement so cough is effective.
 Anti- tuss/ Robitussin/ Mucinex (guaifenesin) Used often;
may increase bleeding tendency. Monitor for bruising or
bleeding especially if taking anticoagulants
 SSKI (iodine products) – use infrequently
Practice
 A 29 year old male comes to the ED with c/o SOB,
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wheezing and chest pain when he coughs.
1. What assessments do you perform?
2. What lab tests should be ordered?
3. Would you start an IV (assume orders are present)? What
kind? Why?
4. What medications would the nurse anticipate being
ordered?
5. What patient teaching should be considered?
 QUESTIONS?