Medication Therapy for Upper Respiratory Disorders - Unit 1

diphenhydramine

prototype for first-generation antihistamines

binds to H1 receptors, blocking release of histamine

expected action of diphenhydramine

just before bedtime

when should diphenhydramine be administered?

at least 30 minutes before activity

when should diphenhydramine be administered when given prophylactically for motion sickness?

sedation/drowsiness

adverse effect of diphenhydramine

anticholinergic

diphenhydramine and cetirizine also have ______ effects

• narrow-angle glaucoma

• prostatic hypertrophy

• acute exacerbation of asthma

• children under 2 years

• breastfeeding women

when should you not give diphenhydramine? (5)

life-threating CNS depression

what can happen when you drink alchohol or take CNS depressants while taking diphenhydramine?

cetirizine

prototype for second-generation antihistamines

antagonizes histamine effects at H1 receptor sites

expected action of cetirizine

peripherally; prophylactically

cetirizine is _____ acting, and is most effective taken ________

• once a day

• do not give with other OTC antihistamines

how should cetirizine be administered?

mild drowsiness and fatigue

adverse effects of cetirizine

• infants under 6 months

• breastfeeding women

• allergy to hydroxyzine

when should you not give cetirizine? (3)

theophylline

______ reduces clearance of cetirizine from the body and can lead to toxicity

CNS depressants

avoid giving other ______ with cetirizine

phenylephrine

prototype for sympathomimetics

abuse/overuse

phenylephrine is rarely prescribed due to ______

rebound congestion

prolonged/overuse of nasal phenylephrine can result in ______

only when necessary for no longer than 3 to 5 days

how should phenylephrine be taken?

nasal glucocorticoid

what minimizes manifestations of rebound congestion?

• activates alpha1-adrenergic receptors in the nose to constrict blood vessels

• causes nasal turbinates to shrink and opens nasal passages

expected action of phenylephrine (2)

• agitation, anxiety, insomnia

• systemic vasoconstriction

adverse reactions to phenylephrine (4)

• narrow-angle glaucoma

• uncontrolled heart disease

• HTN

• dysrhythmia

when should you not give phenylephrine? (4)

coronary artery disease

use caution when giving phenylephrine to patients with _______

MAOI antidepressants

________ potentiate effects of phenylephrine and should not be given within 3 weeks of each other

beta2-adrenergic agonists

_______ potentiate hypertensive effects of phenylephrine

• codeine

• dextromethorphan

prototypes for antitussives (2)

suppresses cough reflex in the brain

expected action of codeine/dextromethorphan

as needed on a short-term basis

how should codeine and dextromethorphan be used?

• drowsiness/sedation

• constipation

• respiratory depression

adverse effects of codeine

abuse

antitussives have potential for ______

• patients taking MAOIs or SSRIs

• reduced respiratory reserve

• chronic coughs

when should you not give antitussives? (3)

opioid analgesics

dextromethorphan increases effectiveness of _______

fever and HPN

what can happen when you give MAOI antidepressants with dextromethorphan?

St. John’s wort

______ increases sedative effects of antitussives

guaifenesin

prototype for expectorants

fluid intake

make sure patients maintain _____ while taking cetirizine to alleviate viscosity of secretions

reduces surface tension of secretions to thin thick mucus

expected action of guaifenesin

• tablets or SR formulations

• only when needed

how is guaifenesin administered?

• dizziness, drowsiness

• n/v

adverse reactions of guaifenesin (3)

PKU

do not give guaifenesin to patients with _____

disulfiram

use caution when giving guaifenesin to patients receiving _______

acetylcysteine

prototype for mucolytics

reverses acetaminophen overdose

what is another use for acetylcysteine?

through a nebulizer or direct instillation through a tracheotomy tube

how is acetylcysteine administered?

• ensure equipment does not contain any metal or rubber parts

• clear airway

• check ability to cough

3 things you should do before administering acetylcysteine via nebulizer

breaks disulfide linkages of proteins in mucus, decreasing its viscosity

expected action of acetylcysteine

• bronchospasm

• rotten-egg smell can precipitate nausea and ingestions of secretions

adverse reactions to acetylcysteine (2)

patients with a risk of gastric bleeding

who should not receive acetylcysteine?