Respiratory meds

Antihistamines MOA

-inhibits histamine 1 receptors (anti-inflammatory)

- prevents vasodilation, reduces flushing

- decreases capillary permeability, reduces edema

- increases drowsiness

- decreases bronchoconstriction, itching & pain, mucus secretion

Antihistamines indication

- mild allergy/ seasonal allergic rhinitis

- motion sickness

- insomnia

- severe allergies (DOC=epinephrine)

Antihistamines route

- po

- intranasal

Antihistamines A/E

- sedation (biggest a/e, especially with first gen)

- dizziness, incoordination, confusion, fatigue

- gi upset

- constipation

- drying of mucous membranes, especially w/ first gen

- palpitations (can worsen htn)

- promethazine (resp. depression & local tissue injury)

Antihistamines interactions

- increase sedation effects & compromised respiratory

- ETOH

- barbiturates

- benzo

- opioids

- sedatives

- cns depressants

- tricyclic antidepressants

- MAO inhibitors

- ototoxic drugs

Antihistamines contraindication

- pregnancy (reports of fetal malformation, benefits vs risk)

AVOID in 3rd trimester!!!!

- lactation (excreted in breast milk, education RT milk supply and potential for infant sedation)

- acute toxicity

dilated pupils, flushed face, hyperpyrexia, tachycardia, dry mouth, urinary retention

IN KIDS - cns exitation (hallucination, seizure, ataxia)

can progress to coma, cardiovascular collapse and death

Antihistamines nursing interventions

- 1st gen: sedation is common, significant anticholinergic properties (cant pee, see, poop, spit), less expensive

- 2nd gen: less sedation, fewer anticholinergic effects, more expensive

- elderly: AVOID 1st gen, clearance decreases with age and tolerance dependance, risk for confusion, increase anticholinergic effects or toxicity, use of diphenhydramine (1st) may be appropriate, acute tx of severe allergic rxn

diphenhydramine class

1st gen anti-histamine

diphenhydramine MOA

blocks histamine actions

diphenhydramine indication

- sneezing

- itchy/watery eyes

- runny nose

- itchy throat

- pre-medicate

diphenhydramine route

- PO

- IV

- use lowest dose possible

diphenhydramine a/e

- very sedating

diphenhydramine contraindication

- AVOID as sedative in children (paradoxical)

- Avoid citric juices

fexofenadine class

2nd gen antihistamine

fexofenadine MOA

- selective peripheral H1 blocker

- blockage prevents H1 receptors activation so prevents

sx associated with allergies from ocurring

- good combo of efficacy & safety among 2nd gen

fexofenadine indication

- sneezing

- itching/watery eyes

- runny nose

- itchy throat

fexofenadine routes

- po

- decrease dose in renal failure pt

fexofenadine a/e

- N/D, upset stomach

- drowsiness

- HA

fexofenadine interactions

- AVOID fruit juices 4 hours before admin and 1-2 hours after

- OJ, grapefruit, apple

azelastine class

- intranasal 2nd gen antihistamine

azelastine moa

- selective peripheral H1 blocker

- blockage prevents H1 receptors activation so prevents

sx associated with allergies from ocurring

azelastine indication

- sneezing

- itchy/watery eyes

- runny nose

- itchy throat

azelastine routes

- intranasal

- 1 spray twice/day for kids 5-11

- 2 spray twice/day for kids 12 or older

azelastine a/e

- drowsiness

- nose bleeds

- HA

- unpleasant taste

glucocorticoids moa

- anti inflammatory

- most effective lt control of airway inflammation

- suppress inflammation

- decrease bronchial hyperactivity

- decrease mucus production

glucocorticoids routes and indication

- fixed schedule (NOT PRN)

- inhaled: use daily w/ persistent asthma, most effective and safer

- po: mod to severe persistent asthma, acute exacerbation management in asthma & copd, tx should be as brief as possible

glucocorticoids a/e

- adrenal suppression

-oropharyngeal candidiasis

- dysphonia

- may slow growth in children

- bone loss w/ lt use

- glaucoma and cataracts w/ continuous high dose

glucocorticoids contraindication

- discontinue lt slowly

- will NOT abort acute asthma attack

- inhaled preferred to po

WITH PO:

- adrenal suppression

- osteoporosis

- hyperglycemia

- pud

- growth suppression in children

bronchodilator moa

- does not alter underlying inflammation

- focused on smooth muscle of lungs

- promotes bronchodilation

bronchodilator indication

- symptomatic relief of asthma and copd

monotherapy in mild asthma w/ infrequent attacks

bronchodilator contraindication

- black box warning= should not be used alone

adjunct therapy with glucocorticoid

montelukast class

- leukotriene modifier

montelukast moa

- blocks receptor activation by leukotrienes

- well tolerated

montelukast indication

- prophylaxis and maintenance of asthma

- prevention of exercise induced bronchospasm

- treat allergic rhinitis

montelukast route

- PO

- not 1st line

- bronchodilator and glucocorticoid FIRST then give this!!!!!!!!!!!!

montelukast a/e

- rare

- neuropsychiatric effects

- suicidal ideation

- depression

montelukast contraindication

- phenytoin= decrease effects

Albuterol (class)

- bronchodilator - short acting

- beta 2 adrenergic agonist

albuterol moa

- thru activation of beta 2 receptors in lung smooth muscle that promotes bronchodilation, relieving bronchospasm exacerbation

albuterol indication

- 1st line DOC for acute asthma attack (resuce inhaler)

- long term or short term control

albuterol route

- inhaled 3-4 times daily, MDI, nebulizer

- daily selective for beta 2 in recommended doses

albuterol A/E

- tremors

- tachycardia

- insomnia

albuterol nursing interventions

- for elderly or pt with CV hx due to side effects we might rx another drug (levalbuterol is the doc)

levalbuterol (class)

- bronchodilator

- short acting beta 2 adrenergic agonist

levalbuterol moa

- thru activation of beta 2 receptors in lung smooth muscle that promotes bronchodilation, relieving bronchospasm exacerbation

levalbuterol indications

- DOC for elderly pt and pt with Cardiac Hx (arrythmias) which is due to s/e compared to albuterol

- PRN for acute attacks

- take before EXERCISE to prevent exercise induced bronchospasm

levalbuterol route

- inhaled SABA

- usually MDI

levalbuterol A/E

- tachycardia

- angina

- tremors

- NO EFFECT ON HR!!!!!!!!!!

- not as many cardiac issues as albuterol

salmeterol (class)

- bronchodilator

- long acting beta 2 agonist

salmeterol route

- inhaled on FIXED SCHEDULE

- (NOT PRN!!!!!)

salmeterol nursing considerations

- use with glucocorticoid in same inhaler IF POSSIBLE

- may need to increase frequency of dose with continued use

- it is frequently combined with fluticasone

- can lead to death if monotherapy with asthma

- NOT 1st LINE

Fluticasone + Salmeterol (Advair) CLASS

- bronchodilator

- long acting beta 2 agonist

- combo

Fluticasone + Salmeterol (Advair) MOA

thru activation of beta 2 receptors in lung smooth muscle which leads to:

- promotes bronchodilation

- relieve bronchospasm

- decrease hyperactivity

- decrease airway mucus production

Fluticasone + Salmeterol (Advair) indications

- long term maintenance (adult and children)

- asthma

- stable copd

Fluticasone + Salmeterol (Advair) route

- inhaled (MDI)

- FIXED SCHEDULE

Fluticasone + Salmeterol (Advair) A/E

- tachycardia

- angina

- tremors

Fluticasone + Salmeterol (Advair) nursing considerations

- approved for children 4+

- may increase dose frequency with continued use

- shake well prior and wait 1 min between each puff

- RINSE MOUTH OUT

theophylline (class)

- methylxanthines

theophylline MOA

- helps with opening airways

- very narrow therapeutic range

theophylline indications

- prevents asthma attacks at night

- stable chronic asthma

- copd: use beta 2 agonist anf glucocorticoids FIRST

- check drug levels, LFTs

theophylline route

- PO,

- IV (emergency- slow to prevent cardiac problems)

theophylline contraindication

- use cation with pt with arrythmia can lead to death

theophylline A/E

- CNS excitation

- bronchodilation

- TOXICITY (n/v/d, insomnia restlessness, LFT, dysrhythmia that leads to convulsion and can lead to death

- draw labs to confirm LFT

- hold med AND NOTIFY DR IF TOXICITY OCCURS

theophylline interactions

- caffeine

- tobacco

- marijuana smoke

ipratropium (class)

- anti cholinergic

ipratropium moa

- improves lung function by blocking muscarinic receptors in bronchi that leads to bronchodilation

- relieves bronchospasm

ipratropium indications

- COPD (FDA approved)

- asthma (off-label use)

- exercise induced asthma

ipratropium route

- inhaled (works in 30sec and lasts up to 6 hours)

ipratropium A/E

- dry mouth

- pharynx irritation

- < tachycardia than albuterom

Fluticasone (class)

- intranasal glucocorticoid

Fluticasone moa

- stimulates glucocorticoid receptors in humans that produce a potent anti-inflammatory response

Fluticasone indications

- most effective drug for prevention and treatment of allergic rhinitis

Fluticasone route

- intranasal

- dose daily

- NOT PRN

- available OTC

Fluticasone A/E

- (systemic effects are rare)

- nasal mucosal drying

- burning or itching sensation

- sore throat

- epistaxis (nosebleed)

- HA

phenylephrine (class)

- sympathomimetic

- decongestant

phenylephrine moa

- causes prolonged and moderate vasoconstriction that leads to decrease membrane swelling and nasal congestion

phenylephrine indication

- nasal congestion

- used IV to tx hypotension

- not as effective when used PO

- NOT ASSOCIATED W/ABUSE

- FAST and EFFECTIVE when used topically

phenylephrine route

- available nasal, PO, IV

Pseudoephedrine (class)

- sympathomimetic

- decongestant

Pseudoephedrine moa

- causes prolonged and moderate vasoconstriction that leads to decrease membrane swelling and nasal congestion

Pseudoephedrine indication

- nasal congestion

- more effective than phenylephrine

- can be converted into methamphetamine

Pseudoephedrine route

- ONLY admin PO

Pseudoephedrine contraindication

- pt w/ CV issues (including HTN)

Pseudoephedrine A/E

- CNS stimulation is lower

- restlessness

- irritability

- anxiety

- insomnia

- generalized vasoconstriction (increase in BP)

Guaifenesin (class)

- expectorant

Guaifenesin moa

- stimulates respiratory secretions, making coughs more productive

- goal = thin secretion/mucus

- often combo w/ dextromethorphan for cough

- if you have cold sx do NOT stack meds

- ONLY TAKE WHAT YOU NEED

Guaifenesin indication

- chest congestion

Guaifenesin route and considerations

- PO

- available OTC

- may need higher than recommended dose to be effective

- increase FLUID INTAKE !!!!!!!