Anti-TB, Antitussives, Antihistamines, Decongestants, Expectorants, 4 Airflow Disorders

isoniazid (INH)

Anti TB

MA:
- Bactericidal or bacteriostatic
- Prevent synthesis of mycotic acid which disrupts the cell wall
- Treat bacterial lungs infection (TB)

IND:
- Treat TB

A/E:
- Peripheral neuropathy (decreased sensation)
- Hepatotoxicity (watch for liver, jaundice in the eyes or skin)
- Monitor LFTs (Liver Function Tests)
- "Pyridoxine" (a vitamin is usually prescribed w/ INH, this is a similar concept of with taking probiotic when taking w/ ABX)

N/C:
- Drug therapy is long-term: 6-12 months
- Report adverse effects
- Pt must take medication as prescribed to avoid TB drug resistance
- Follow-up sputum collection for acid-fast bacillus (AFB)
- AVOID or have NO alcohol (bc it can further damage the liver)

rifampin

Anti TB

MA:
- Bactericidal
- Blocks DNA/RNA synthesis

IND:
- Treat TB

A/E:
- Orange discoloration of body fluids
tears, urine, saliva, sweat, sputum
- NOT life threatening, this is EXPECTED for pt who take rifampin
- Hepatotoxicity (watch for liver, jaundice in the eyes or skin)
- Monitor LFTs (Liver Function Tests)

N/C:
- Drug therapy is long-term: 6-12 months
- Report adverse effects
- Pt must take medication as prescribed to avoid TB drug resistance
- Follow-up sputum collection for acid-fast bacillus (AFB)
- AVOID or have NO alcohol (bc it can further damage the liver)

*** Rifapentine and Pyrazinamide are often used in conjunction with Isoniazid or Rifampin

ethambutol

Anti TB

MA:
- Bacteriostatic
- Exact MA unknown
- Blocks the growth of mycobacteria

IND:
- Treat TB

A/E:
- Blindness (go for routine eye exam
report any blurry and trouble seeing to the physicians)
- Hepatotoxicity (watch for liver, jaundice in the eyes or skin)
- Monitor LFTs (Liver Function Tests)

N/C:
- Drug therapy is long-term: 6-12 months
- Report adverse effects
- Pt must take medication as prescribed to avoid TB drug resistance
- Follow-up sputum collection for acid-fast bacillus (AFB)
- AVOID or have NO alcohol (bc it can further damage the liver)

codeine

Antitussives (Opioids)

MA:
- Works on CNS system to increase cough threshold

IND:
- Decrease frequency and intensity of nonproductive cough

A/E:
(CNS)
1. dizziness
2. lightheadedness
3. drowsiness
4. respiration depression (Ask myself "Is the pt resp stable enough to give them this med base off their RR 12-20?")

S/E:
GI: (nausea, vomiting, constipation)

dextromethorphan (Robitussin)

Antitussives (Non-opioids)

MA:
- Works on CNS to suppress cough

IND:
- Suppress cough

A/E:
- Dizziness
- Sedation
- Nausea

Sedating: diphenhydramine (Benadryl), promethazine (Phenergan)

Non-sedating: loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec)

Antihistamines

MA:
- Block histamine
- Compete at sites on cell

IND:
- Nasal allergies
- Rhinitis (viêm mũi)/seasonal allergies
- Allergic reactions
- Motion sickness
- Parkinson's disease
- Sleep disorders
- Common cold

A/E:
- Drying effect
- Anticholinergic effect - "SLOW DOWN" ("reduced urination, reduced lacrimation, reduced saliva, reduced defecation")
- Drowsiness: mild to deep sleep

Sedating:
- diphenhydramine (Benadryl) --> watch driving, operating machines, take with sugarless hard candy if dry mouth occurs
- promethazine (Phenergan) -->
anti-nausea effects usually with surgery/motion sickness)

Non-sedating
- loratadine (Claritin)
- fexofenadine (Allegra)
- cetirizine (Zyrtec)

pseudoephedrine (Sudafed), phenylephrine (Neo-Synephrine)

Decongestants

MA:
- Constrict blood vessels that supply secretions (mucous secretions)
- TURN OFF INFLAMMATION CELLS
- Shrink engorged membranes

IND:
- People with nasal congestion and swelling of nasal passage

A/E:
- Agitation
- Nervousness
- Vasoconstriction (increase BP)
- Heart palpitation
- Insomnia
- Tremors

C/I:
- WATCH for rebound congestion if used for more than 5 days
- DO NOT use in closed angle glaucoma
- This type of med using VASOCONSTRICTING properties
PEOPLE WITH HYPERTENSION!

ORAL
- pseudoephedrine (Sudafed)

TOPICAL
- phenylephrine (Neo-Synephrine) -->
used to treat the itching, swelling, and pain of hemorrhoids (growth from the rectal area)

guaifenesin (Mucinex)

Expectorants

MA:
- Stimulate cough reflex
- COUGH OUT SECRETIONS

IND:
1. Productive coughs
- Common cold
- Bronchitis
- Laryngitis
- Pharyngitis
- Coughs caused by chronic paranasal sinusitis
- Pertussis
- Influenza
2. Removal of mucous

A/E:
- Dizziness
- GI upset
- Rash

N/C:
- REMEMBER -> good hydration THINS out secretions!!!
- Suggestions to take with a full glass of water
- Report excessive sedation, confusion, or hypotension
- AVOID driving or operating heavy machinery
- Advise against consuming alcohol or other CNS depressants.
- DO NOT take these medications with other prescribed or OTC medications without checking with their prescribers
- If dry mouth occurs --> teach patients to perform frequent mouth care, chew gum, or suck on hard candy (preferably sugarless) to ease discomfort

Acetylcysteine (Mucomyst)

Expectorants

MA:
- Thin secretions

IND:
- Those with thick secretions

A/E:
- Aspiration and bronchospasm when administered orally
- Be sure the airway is adequate!!
- Hepatotoxicity
- Concern for sedation anticholinergic effects
- GI upset
- Hallucinations in children
- Respiration depression
- Smells like rotten eggs

ipratropium (nasal), tiotropium (inhaler)

Anticholinergics: allow airway to relax and open

MA:
- Block ACH (ACH: acetylcholine- neurotransmitter; causes muscles to contract; activates pain); so it dilates the bronchioles
- Remember ACH → "dry and slowing down"

IND:
- Bronchoconstriction
- NOT FOR ACUTE ASTHMA ATTACK (these have slow, prolonged action)
- Use for asthma maintenance

A/E:
- Drying
- Constipation
- Urinary retention
- Heart palpitations
- Heart attack
- Cough
- Anxiety

N/C:
Wait 5 min between different inhaled meds

albuterol, salmeterol, terbutaline

Beta2 adrenergic agonists

MA:
- Dilation of airways; relax smooth muscle in bronchi/bronchioles

IND:
- Relief of bronchospasm r/t ASTHMA, BRONCHITIS, PULMONARY DISEASES
treatment/prevention of ACUTE ATTACKS

A/E:
1. albuterol
- For ACUTE asthma attack
- Inhaled SABA (short acting beta agonist)
- Oral LABA (longer acting beta agonist)

2. salmeterol, terbutaline
- Tremors
- Angina
- H/A
- Changes in BP
- Palpitations

3. epinephrine
- Quickly open the airway → ANAPHYLACTIC ALLERGIC RXN!
- Insomnia
- Restlessness
- Anorexia
- H/A from vasodilation
- Increased B.S
- Tremor
- Heart palpitation

beclomethasone, prednisone

Glucocorticosteroids: chronic conditions

MA:
- Anti-inflammatory
-Decrease bronchoconstriction
- CAN BE WEEKS BEFORE FULL EFFECTS

IND:
- CHRONIC asthma (NOT acute attacks)
- Reduce inflammation

A/E:
- Pharyngeal irritation
- Cough
- Dry mouth
- Oral fungal infections no spacers
- WATCH blood sugars (can raise blood sugar, monitor B.S. within control)

Examples:
1. Beclomethasone
- RINSE after use (risk of thrush)

2. Prednisone
- Watch for myopathy
- PUD (peptic ulcer disease)
- Infection (lower the immune response, cause pt at higher risk for infection)
- Wt gain
- Adrenal insufficiency (d/t pt stop abruptly bc adrenal glands DOES NOT have enough time to function back up)
- Bone density decrease (decrease platelet, WBCs
- Increased blood sugar

N/C:
- If using a bronchodilator and steroid
--> Use bronchodilator first
--> THEN steroid 2nd → OPEN THEN DECREASE INFLAMMATION/ SWELLING IN AIRWAY
- DO NOT ABRUPTLY STOP!!
- Risk of adrenocortical insufficiency
- Promote active ROM

montelukast (Singulair, Zafirlukast)

Leukotriene modifiers (Leukotriene Receptor Antagonists): stop the effect of trigger at the site of the cells, good for asthma

MA:
- Prevention of leukotriene attachment to cells → this then decreases inflammation
- Decreases bronchoconstriction
- Decreases coughing, wheezing, SOB

IND:
- Prophylaxis/treatment of asthma (NOT ACUTE asthma attack)
- Allergic rhinitis

A/E:
- H/A
- Nausea
- Dizziness
- WATCH LIVER (hepatic impairment)

N/C:
- Watch for depression
- It is used in children as young as 12 months of age

theophylline, theobromine

Xanthine Derivatives: can use for all conditions

MA:
- Smooth muscle relaxation
- Bronchodilating
- Increases airflow

IND:
- Asthma
- Bronchitis, emphysema (COPD)

A/E:
- N/V
- Reflux
- Dysrhythmias (talk to physicians if you might experience flutter in the chest
Increased blood sugar)

N/C:
- Theophylline, Theobromine - long term therapy (ATI 5-15 level in blood; 10-20- text)
- WATCH CAFFEINE WITH USAGE!!
Increased CNS stimulation with combo
- Be cautious with peptic ulcer disease/ GI/ cardiac