Transcript Chain of Survival and EMSC

Allergy and Respiratory
Medications
Copyright © 2016 by Mosby, an imprint of Elsevier
Inc.
Respiratory System
 Upper Respiratory
System
 Oral and nasal cavity,
sinuses, pharynx,
larynx, and trachea
 Lower Respiratory
System
 Right and left bronchi,
right and left lungs,
bronchioles, and alveoli
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Antihistamines
 Two types: Histamine H1-receptor antagonists and histamine
H2 antagonists
 First-generation or second-generation drugs are further divided into six
main groups
 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 GI system
 Sedative effect on the CNS
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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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Antihistamines (cont.)
 Side Effects
 Constipation, blurred vision, dry mouth, urinary
retention, dried thickened secretions
 Adverse Reactions
 Tachycardia, confusion, dizziness, insomnia, nausea
 Restlessness, excitability, sedation, tinnitus, dysuria,
impotence, photosensitivity
 Drug Interactions
 Nursing Process
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Antihistamines (cont.)
 Lifespan 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
(light-headedness and fainting), confusion and
extrapyramidal reactions
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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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Antitussives (cont.)
 Adverse Reactions
 Drowsiness, dry mouth, nausea, postural hypotension
 Drug Interactions
 Nursing Process
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Asthma Medications
 Overview
 Asthma is a condition that involves increased
inflammation, swelling, and mucus production that lead
to bronchiolar constriction. The person is able to breathe
air into the lungs but has difficulty breathing out.
Wheezing results because the person works to force air
out through narrowed, mucus-filled passages during
expiration.
 The four classes of asthma severity include mild
intermittent, mild persistent, moderate persistent, and
severe persistent.
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Asthma Medications (cont.)
 COPD is a chronic, disabling disorder that causes
destruction of alveolar walls. This destruction creates
unequal areas of ventilation and perfusion in the body,
and oxygen and carbon dioxide exchange is impaired.
Patients experience difficulty in expiration.
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Asthma Prophylaxis Medications
 Prophylactic treatment
 Cromolyn sodium
 Nedocromil sodium
 Actions:
 Works at the surface of the mast cell as a mast cell
stabilizer to prevent the release of histamine,
leukotrienes, and slow-reacting substances of
anaphylaxis.
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Bronchodilators
 Sympathomimetics
 Relax smooth muscle of bronchi (dilate)
 Vasoconstriction of blood vessels in body (decreases
mucosal and submucosal edema)
 Increase the rate and force of heart contraction
 Uses:
 Relief of symptoms of bronchospasm in acute or chronic
asthma, bronchitis, and COPD
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Bronchodilators (cont.)
 Anticholinergics
 Block cholinergic receptors in the airways of the lung
causing decreased contractility of smooth muscle.
 Uses:
 Manage respiratory symptoms of cough, difficulty
breathing, and mucous production.
 Primarily used in the treatment of COPD.
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Bronchodilators (cont.)
 Xanthines
 Relax smooth muscle in the bronchi and blood vessels
in the lungs
 Directly act on the kidney to produce an increase in
urine production
 CNS effects
 Uses
 Adjunctive therapy for bronchospasm in acute and
chronic bronchial asthma, bronchitis, emphysema
 Treatment of neonatal apnea
 Acute pulmonary edema
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Leukotriene Receptor Inhibitors
 Montelukast (Singulair), zafirlukast (Accolate), and
zileuton (Zyflo CR)
 Reduce symptoms of asthma by blocking receptors for
cysteinyl leukotrienes C4, D4, and E4
 Uses
 Treat acute or chronic asthma in patients unable to take
inhaled glucocorticoids
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Corticosteroids
 Block reaction to allergens and reduce airway
hyperresponsiveness
 Inhibit cytokine production, protein activation, and
inflammatory cell migration and activation
 Uses
 Inhaled, long-term asthma control
 Systemic; often used to get quick control of the disease
when beginning long-term therapy or to speed recovery
from severe episodes
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Decongestants
 Directly affect alpha receptors of blood vessels in the
nasal mucosa, causing vasoconstriction
 Uses:
 Relieve nasal congestion from allergies and upper
respiratory infections
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Expectorants
 Decrease the thickness of respiratory secretions, which
facilitates expectoration
 Uses:
 Treat productive cough, assist with thick mucus
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Topical Intranasal Steroids
 Action
 Antiinflammatory, reduce nasal congestion
 Uses
 Treatment of allergic, mechanical, or chemically
induced local nasal inflammation or nasal polyps
when usual treatment has failed to work
 Adverse reactions
 Asthma, headache, lightheadedness, loss of sense of
smell, nasal irritation and dryness, nausea,
nosebleeds, perforation of nasal septum, altered
sense of taste and smell
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