Transcript Chapter 38

Chapter 40
Drugs for Upper Respiratory Disorders
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Upper Respiratory Disorders

Upper respiratory infections

Common cold
• Etiology: rhinovirus
• Affects nasopharyngeal tract
 Acute rhinitis
• Inflammation of nasal mucous membranes
 Sinusitis
• Inflammation of mucous membranes of sinuses
 Acute pharyngitis
• Inflammation of throat
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Upper Respiratory Disorders (Cont.)

Contagious period of common cold



Transmission



1 to 4 days before onset of symptoms
During first 3 days of cold
Touching contaminated surfaces, then
touching nose or mouth
Viral droplets from sneezing
Symptoms of common cold

Nasal congestion, nasal discharge, cough,
increased mucosal secretions
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Antihistamines

H1-blockers (H1 blockers or H1 antagonists)
can cause drowsiness, dizziness, fatigue, and
disturbed coordination

First-generation antihistamines
• Diphenhydramine (Benadryl)
 Second-generation antihistamines
 Nonsedating antihistamines
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Loratadine (Claritin)
• Azelastine (Astelin)
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Antihistamines (Cont.)

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
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Antihistamines (Cont.)

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
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Nursing Process: Diphenhydramine
(Benadryl)




Assessment
Nursing diagnoses
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
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Nursing Process: Diphenhydramine
(Benadryl) (Cont.)

Diphenhydramine (Benadryl)

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.
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Second-Generation Antihistamines





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Nonsedating antihistamines
Fewer anticholinergic symptoms
Cetirizine (Zyrtec)
Cexofenadine (Allegra)
Loratadine (Claritin)
Azelastine (Astelin)
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Nasal Congestion

Nasal congestion
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

Dilation of nasal blood vessels
• Due to infection, inflammation, allergy
Transudation of fluid into tissue spaces
• Leads to swelling nasal cavity
Nasal decongestants: Systemic
decongestants

Stimulate alpha-adrenergic receptors
• Produces nasal vascular vasoconstriction
• Shrinks nasal mucous membranes
• Reduces nasal secretion
• Rebound nasal congestion
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Nasal Congestion (Cont.)

Systemic decongestants

Used primarily for allergic rhinitis, including hay
fever and acute coryza
• Ephedrine (Ephedrine),
• Phenylephrine (Neo-Synephrine)
• Pseudoephedrine (Sudafed)
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Nasal Decongestants (Cont.)
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





Ephedrine HCl (Primatene)
Naphazoline HCl (Privine)
Oxymetazoline (Afrin)
Phenylephrine HCl (Neo-Synephrine Nasal)
Pseudoephedrine (Sudafed)
Tetrahydrozoline (Tyzine)
Administration
Nasal spray, nasal drops, tablet, capsule,
liquid
Interactions
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Nasal Decongestants (Cont.)
 Side


effects
Nervousness, restlessness, “jitters”
Alpha-adrenergic effect (hypertension,
hyperglycemia)
 Frequent
use
May lead to tolerance
 May lead to rebound nasal congestion
 Should not use more than 5 days

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Intranasal Glucocorticoids
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
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
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Beclomethasone (Beconase, Vancenase,
Vanceril)
Budesonide (Pulmicort, Rhinocort)
Dexamethasone (Decadron)
Flunisolide
Fluticasone (Flonase, Flovent)
Triamcinolone (Nasacort)
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Intranasal Glucocorticoids (Cont.)

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.
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Expectorants

Guaifenesin (Robitussin)

Action
• Loosens bronchial secretions by reducing surface
tension of secretions

Use
• Dry, nonproductive cough
 Side effects
• Drowsiness, nausea
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Antitussives

Act on the cough-control center in the
medulla to suppress the cough reflex


Three types of antitussives are nonnarcotic,
narcotic, or combination preparations.
Dextromethorphan (Benylin)
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Nursing Process: Common Cold




Assessment
Nursing diagnoses
Planning
Nursing interventions



Patient teaching
Cultural considerations
Evaluation
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Sinusitis and Pharyngitis

Sinusitis

Treatment
• Decongestant, acetaminophen, fluids, rest,
antibiotics

Acute pharyngitis

Treatment
• Saline gargles, lozenges, increased fluid intake,
acetaminophen
• Antibiotics with bacterial infection
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Practice Question #1
A patient is receiving dextromethorphan
(Benylin). The nurse knows the drug is
exerting its therapeutic effect when the
patient experiences
A.
B.
C.
D.
thinning of secretions.
bronchodilation.
decreased coughing.
relief of nasal congestion.
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Practice Question #2
The nurse is teaching an older adult patient
about guaifenesin (Robitussin). Which
information is appropriate to include in this
teaching? (Select all that apply.)
A. Take the drug with a glass of water.
B. Read labels on over-the-counter drugs and check
with health care provider before taking cold
remedies.
C. Take the drug at bedtime.
D. Advise patient to contact health care provider if
cough persists more than 2 days.
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Practice Question #3
A patient has been diagnosed with the
common cold. The nurse should question
if which drug is ordered to treat this
patient?
A.
B.
C.
D.
Antihistamines
Antitussives
Expectorants
Antibiotics
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Practice Question #4
Which medication is a first-generation
antihistamine?
A.
B.
C.
D.
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Diphenhydramine (Benadryl)
Loratadine (Claritin)
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Practice Question #5
When teaching a patient about use of nasal
decongestant sprays, the nurse informs the
patient that they are most effective when
administered for how many days?
A.
B.
C.
D.
4 days
10 days
14 days
20 days
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Practice Question #6
Before administering diphenhydramine
(Benadryl) to a patient, it is most important for
the nurse to assess the patient for a history of
A.
B.
C.
D.
allergy to penicillin.
hypertension.
diabetes mellitus type 2.
narrow-angle glaucoma.
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Practice Question #7
Which statement about dextromethorphan
does the nurse identify as being true?
A.
B.
C.
D.
It is a narcotic antitussive.
It suppresses the cough center of the medulla.
It suppresses respirations.
It causes physical dependence.
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