Transcript CB064-4.19 - Workforce3One

Respiratory Medications
NUR 154
Pharmacotherapeutics
Upper Respiratory Disorders
 Allergic
Rhinitis - Nasal mucosa react to
allergen.
S/S: Sneezing, rhinorrhea (runny nose), nasal
itching, watery eyes, congestion
 Medication Management
Drug therapy: Antihistamines are the drugs of choice
 Benadryl, Claritin
 Common S.E.’s: Sedation, dry mouth, urinary
retention, constipation (anticholinergic S.E.’s),
Insomnia, nervousness, irritability
Lower Respiratory Disorders
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Obstructive
– Narrowed air passages
– Increased turbulence
(secretions)
– Increased resistance to air flow
– S/S = bronchospasm, edema,
inflammation, excessive
mucous secretion
– Examples:
– Chronic obstructive
pulmonary disease or COPD
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Asthma
Bronchitits
– Cystic fibrosis
Lower Respiratory and Related Medications
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Expectorants
– Liquefy mucous by stimulating secretion of lubricant
fluids in larger airways
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Can increase effectiveness of ciliary action and coughing
– Guaifenesin (Robitussin)
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Used in acute coryza (common cold), bronchitis, pharyngitis,
sinusitis, laryngitis, COPD
Used in combination with other resp. agents, such as
bronchodilators, decongestants, and antihistamines
– Therapeutic Outcome
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Reduced frequency of nonproductive cough, increased
expectoration of phlegm.
Lower Respiratory and Related Medications
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Antitussive Agents
– Suppress cough center in brain
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Used to suppress bothersome dry, hacking, nonproductive
cough
– ***NOT normally used to suppress productive cough***
– Codeine is the “gold standard”
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Usu. low doses, short duration of use to avoid long-term
dependence
Causes resp. depression in higher doses
Side Effects: Drowsiness, sedation, constipation; enhanced
CNS depression with other like agents, such as alcohol,
sedatives, antihistamines, phenothiazines
– Dextromethorphan
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Does not cause respiratory depression or dependence!
Drug of choice for children – Is in many OTC meds
Lower Respiratory & Inhalant Medications
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Beta-adrenergic Bronchodilators
– Stimulation of beta receptors relaxes smooth
muscle of bronchi; if non-selective, stimulate
beta receptors of heart muscle
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S.E.’s: Tachycardia, palpitations, nervousness,
tremors; N/V
– Notify MD of an increase of 20 or > beats per minute
– Mainstay of asthma therapy and COPD
 *Ideally – should wait ten minutes between inhalations
– Common types: Albuterol (acute); Serevent
(nonacute);
Lower Respiratory & Inhalant Medications
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Anticholinergic Bronchodilators - Atrovent
– Blocks cholinergic receptors in bronchial smooth muscle,
with minimal anticholinergic side effects
– S.E.’s: Dry mouth and throat irritation, should resolve in ~
1st – 2nd week of use.
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Mainstay of asthma and COPD treatment; oftentimes
combined in nebulizer treatment with Albuterol
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*If more than 1 inhaler is ordered, you administer
corticosteroids to open bronchial before
administering other inhalers.
Respiratory Anti-inflammatory Medications
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Corticosteroids – Advair disk, Flovent
– Smooth muscle relaxation and decrease inflammation.
– P.O., IV (Prednisone or methylprednisone) or Inhalants –
Flovent is a traditional aerosol inhalant
– Advair is dry powder inhalant (DPI)
for asthma, or COPD
– Side effects
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Inhalant – oral thrush, dysphonia (spacer, gargle, and rinse after
each use)
P.O. or IV use: Increased susceptibility to infections,
hyperglycemia, mood swings, delayed wound healing
Never d/c these drugs abruptly, as they cause adrenal suppression of
pt.’s own cortisol production. Always taper gradually!
Lower Respiratory and Related Medications
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Xanthine Derivatives – Aminophylline, Theophylline
– Relaxes smooth muscle of airways
– Acute management – IV administration
– Side effects: GI upset (^ gastric acid), tachy, palpitations,
nervousness
– This category can inhibit the effects of Beta Blockers and
lithium
– Chronic management – Oral medication, such as Theodur
Lower Respiratory and Related Medications
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Leukotriene Inhibitors – Zafirlukast (Accolate)
– Inhibit inflammatory mediators which trigger asthma,
thereby reducing potential for edema, increased mucous
and airway constriction
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These are not bronchodilating agents
– Do not use for acute attacks!
– S.E.’s: HA, nausea – subsides with continued therapy
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Take with food or milk.
– *Increases effects of theophylline and warfarin!
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Monitor closely and expect decreased doses of these other meds
Lower Respiratory and Related Medications
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Acetylcysteine (Mucomyst)
– Inhalant which liquefies and reduces viscosity of
mucous secretions
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Used in emphysema, COPD, bronchiectasis and pneumonia
clients
Allows easier removal of secretions by coughing, percussion
and postural drainage
Wash client’s face and hands after administration to reduce
chance for irritation.
S.E.’s: N/V (drug has a rotten egg smell), bronchospasm.
– Do not administer concurrently with antibiotics
– **This Drug is also given orally as the antidote to
Tylenol overdose**
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