Proteus, Klebsiella, E. coli
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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