Chapter 54: Drugs acting on the upper respiratory tract

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.