Pharm chapter 36 nasal decongestants exam 4

What do intranasal decongestants do?

Decongestants shrink engorged nasal mucus membranes to relieve nasal stuffiness

Three main types of intranasal medications:

–Adrenergics: Sympathomimetics

–Intranasal Anticholinergic: Parasympatholytic

–Corticosteroids

Adrenergics: Sympathomimetics nasal decongestant

Shrink blood vessels surrounding the nasal sinuses allowing better drainage

Intranasal anticholinergic: parasympathetic nasal decongestants

•Inhibit salivary and mucous gland secretions

Corticosteroids nasal decongestants:

•Reduce inflammation to improved comfort and air exchange

Systemic oral decongestant compared to topical nasal decongestant:

No rebound congestion

Systemic effects of oral decongestants:

–Increases BP, HR

–Palpitations

Topical adrenergic nasal decongestant:

–Prompt onset

–Potent

–Use > 3 days causes rebound congestion, making the condition worse. Limit to use of only 3 days.

–Ephedrine, oxymetazoline (Afrin), phenylephrine (Neo-Synephrine)

Systemic effects of topical adrenergic nasal decongestants:

•Systemic effects:

–Increases BP, HR

–Palpitations

How often can Topical adrenergic nasal decongestants be used?

Should not be used less than 3 days to prevent rebound congestion, should not be used more than 3 days

Nasal decongestants mechanism of action:

•Site of action: blood vessels surrounding nasal sinuses

Adrenergic effects of nasal decongestants:

–Constrict small blood vessels that supply upper respiratory tract structures

–As a result, these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain.

Adverse effects of nasal decongestants:

Nervousness, insomnia, increase BP & heart rate, palpitations, and tremors.

What are intranasal steroids used for?

•used prophylactically to prevent nasal congestion in patients with chronic upper respiratory tract symptoms

Intranasal steroids meds examples:

Beclomethasone dipropionate (Beconase), budesonide (Rhinocort), flunisolide (Nasalide), fluticasone (Flonase), triamcinolone (Nasacort), ciclesonide (Omnaris)

Intranasal steroids mechanism of action:

–Anti-inflammatory effect

–Work to turn off the immune system cells involved in the inflammatory response

–Decreased inflammation results in decreased congestion.

Common adverse effect of intranasal steroids:

local mucosal irritation and dryness

Patients on nasal decongestants should avoid intake of what?

Caffeine

What does coughing do?

–Removes excessive secretions

– Removes potentially harmful foreign substances

What are the two types of cough?

Productive cough- congested, removes excess secretions

Non productive cough- dry cough

Antitussive drugs are used only for:

Non productive coughs

Antitussive opioids mechanism of action:

Suppress the cough reflex by direct action on the cough center in the medulla

Ex. codeine, hydrocodone

Antitussive non opioids mechanism of action:

•Dextromethorphan (in products like Robitussin): works in the same way as opioids having direct action on the cough center but

–Not an opioid

–No analgesic properties

–No CNS depression

What is the antitussive Benzonatate (Tessalon Perles)

Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and prevent reflex stimulation of the medullary cough center

What are expectorant drugs?

•Drugs that aid in the expectoration (removal) of mucus

Expectorants mechanism of action:

•Reflex stimulation

–Loosening and thinning of respiratory tract secretions occurs in response to this irritation

–Causes irritation of the GI tract

•Result: thinner mucus that is easier to remove

Expectorants drug effect:

•By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished.

Indications for expectorants:

•Used for the relief of productive coughs associated with:

– Common cold 

– Bronchitis 

– Laryngitis

– Pharyngitis

– Coughs caused by chronic paranasal sinusitis

– Pertussis

– Influenza

– Measles

–Thick mucus in the respiratory tract with tracheostomy

What should the nurse recommend the patient intake more of when taking expectorants?

•Patients taking expectorants should receive more fluids, if permitted to help loosen and liquefy secretions.