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What are antitussives?
They block the reflex to cough.
What are decongestants?
Decreased the blood flow to the upper respiratory tract and decrease the overproduction of secretions.
What are antihistamines?
These bloc the release or action of histamines that increases secretions and narrows airways.
What is expectorants?
Increase productive cough to clear ariways?
What are mucolytics?
Increase or liquefy respiratory secretions to aid clearing of airways.
What are the two antitussives that we need to know?
Codeine (opioid) and Dextromethorphan (nonopiod)
What are the actions of antitussives?
They act directly on the medullary cough center of the brain to depress the cough reflex.
What are the indications of antitussives?
Control nonproductive cough
What are the contraindications of antitussives?
Patients who need to cough to maintain the airway and head injury or impaired CNS.
What are the cautions of antitussives?
Hypersensitivity or history of narcotic addictions
What are the adverse effects of antitussives?
Drying effect on the mucous membranes and CNS adverse effects and GI upset.
What are the drug to drug interactions with antitussives?
MAOIs
What should you asses when dealing with antitussives?
History, physical exam, allergies, temperature, respiration, adventitious lung sounds.
What are topical nasal decongestants? (phenylephrine)
They decrease the overproduction of secretions by causing vasoconstriction to the upper respiratory tract.
Topical nasal decongestants actions (phenylephrine)
Sympathomimetic, affects sympathetic nervous system to cause vasodilatation, causing less inflammation of the nasal membrane.
Topical nasal decongestants Indications (phenylephrine)
These relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis and allergic rhinitis.
Topical nasal decongestants Pharmacokinetics (phenylephrine)
This is generally not absorbed systemically and any potion of these topical decongestants that is absorbed is metabolized and excreted normally.
Topical nasal decongestants contraindications (phenylephrine)
Lesions or erosion in the mucous membranes.
Topical nasal decongestants cautions (phenylephrine)
Any conditions that might be exacerbated by sympathetic activity.
Topical nasal decongestants adverse effects (phenylephrine)
Local stinging and burning, rebound congestion and sympathomimetic effects.
Oral decongestants (pseudophedrine)
These decrease nasal congestion related to the common cold, sinusitis and allergic rhinitis.
Oral decongestants (pseudophedrine) Actions
Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes.
Oral decongestants (pseudophedrine) Indications
Promotion of drainage in the sinuses and improving air flow.
Oral decongestants (pseudophedrine) contraindications
Any condition that might be exacerbated by sympathetic activity.
Oral decongestants (pseudophedrine) adverse effects
There is no rebound congestion and there is sympathetic effects
Oral decongestants (pseudophedrine) Drug to drug interactions
OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects.
Topical nasal steroid decongestants (fluticasone) actions
Relieves inflammation and exact mechanism of action is not know.
Topical nasal steroid decongestants (fluticasone) indications
Seasonal allergic rhinitis and inflammation after the removal of nasal plyps
Topical nasal steroid decongestants (fluticasone) pharmacokinetics
Generally not absorbed systemically
Topical nasal steroid decongestants (fluticasone) Contraindiation
Acute infection.
Topical nasal steroid decongestants (fluticasone) pharmacokinetics
Generally not absorbed systemically
Topical nasal steroid decongestants (fluticasone) cautions
Active infection and avoid exposure to airborne infections
Topical nasal steroid decongestants (fluticasone) adverse effects
Local burning, irritation, stinging, dryness of the mucosa, headache, suppression of healing (if patient has had nasal surgery or trauma)
Antihistamines (dihenhydramine)
These relieve respiratory symptoms and treat allergies.
Antihistamines (dihenhydramine) actions
Selectively block the effects of histamine at the histamine receptor site, which decrease allergic response. These are both anticholinergic and antipruritic.
Antihistamines (dihenhydramine) Indications
Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria and angioedema.
Antihistamines (dihenhydramine) cautions
Renal/Hepatic impairment and history of arrhythmias.
Antihistamines (dihenhydramine) adverse effects
Drowsiness and sedation, anticholinergic effects
Antihistamines (dihenhydramine) drug to drug interactions
These can vary based on the drug
Expectorants (Guaifenesin)
These increase productive cough to clear the airways. They liquefy lower respiratory tract secretions, reducing the viscosity of the secretions and make it easier for the patient to cough.
Expectorants (Guaifenesin) actions
Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of the fluids. Allowing easier movements of the less viscous secretions.
Expectorants (Guaifenesin) Indications
Symptomatic relief of respiratory conditions characterized by dry, non-productive cough.
Expectorants (Guaifenesin) adverse effected
GI symptoms, headache, dizziness, mild rash. A prolonged use may result in masking a serious underlying disorder.
Mucolytics (acetylcysteine)
Increase or liquefy respiratory secretion to aid the clearing of airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.
Mucolytics (acetylcysteine) actions
Work to break down mucous in order to aid the high-risk respiratory patient in coughing up tick, tenacious secretions
Mucolytics (acetylcysteine) Indications
Patient who have difficulty cough up secretions, developed atelectasis, undergoing diagnostic bronchoscopy, Post op patients and patients with trachs.
Mucolytics (acetylcysteine) Pharmacokinetics
Via nebulization or direct instillation into trachea.
Mucolytics (acetylcysteine) causations
Acute bronchospasm, peptic ulcer and esophageal varicies.
Mucolytics (acetylcysteine) Adverse effects
GI upset, stomatitis or rhinorrhea, bronchospasm and rash.
