Drugs Acting on Upper Respiratory Tract

H1 Blockers

Ioratadine (Claritin), Cetirizine (Zyrtec), Diphenhydramine (Benadryl)

1st Generation Antihistamines

• Cross the blood-brain barrier and block central as well as peripheral H1 receptors

• Cause sedation, drowsiness, fatigue, and imparied alertness and concentration

• Typically short acting

• Examples: Diphenhydramine

2nd Generation Antihistamines

• Act more selectively on peripheral H1 receptors with minimal CNS penetration

• Longer lasting but may not be as effective in severe allergic reactions

• Examples: Cetirizine, Loratadine

Anticholinergic Properties

• Drying effect that reduces nasal, salivary, and lacrimal gland secretions:

  • Difficulty urinating

  • Constipation/Obstruction

  • Changes in vision

  • Drowsiness

  • Tachydysrhythmias

  • Insomia

  • Euphoria

  • Confusion

  • Agitation

  • Tremor

  • Anxiety

Antihistamines Contraindications

• Known hypersensitivity (Paradoxical effect)

• Cardiac disease, hypertension

• Geriatric population

Antihistamines Nursing Implications

Instruct patients to avoid driving or operating heavy machinery and to stop consuming alcohol or other CNS depressants

Oral Decongestants

• Alpha-adrenergic agonists

• No rebound congestion

• Example: Pseudoephedrine (Sudafed)

Oral Decongestants Adverse Effects

Sympathomimetic Effects:

• Hypertension

• Insomnia

• Restlessness

• Tachycardia, palpitations, arrhythmias

• Drying effect

Oral Decongestants Contraindications

• Patients with any condition that might be exacerbated by sympathetic activity

  • Uncontrolled cardiac disease or HTN

  • High risk for stroke

  • Glaucoma

  • BPH

  • Uncontrolled Diabetes

  • Hyperthyroidism

Topical Nasal Adrenergic Decongestants

• Examples: Oxymetazoline (Afrin)

• Sustained use (over 3 days) causes rebound congestion

Topical Nasal Corticosteroid Decongestants

Fluticasone (Flonase); NO rebound congestion

All Decongestants Nursing Implications

• Patients should report a fever, cough, or other symptoms lasting longer than 1 week

• Educate patients to not take topical nasal adrenergic decongestants for more than 3 days

Antitussives

• Drugs that suppress or stop the cough reflex

• Should only be used for non-productive coughs

Antitussives Mechanism of Action

• Peripherally acting (working on lung receptors): Benzonatate (Tessalon Perles)

• Centrally acting (working on CNS):

  • Non-Opioid: Dextromethorphan (Robitussin)

  • Opioid: Codeine

Opioid Antitussives

• Effects: analgesia, drying mucosa of respiratory tract, increased viscosity of respiratory secretions, reduction of runny nose and postnasal drip

• Example: Codeine

Antitussives Contraindications

• If patient has asthma and emphysema

• If patient has a cough lasting more than 1 week

Antitussives Adverse Effects

• Benzonatate: Dizziness, headache, nausea

• Dextromethorphan: Dizziness, drowsiness, nausea

• Opioids: Sedation, nausea, vomiting, lightheadedness, constipation

Antitussives Nursing Implications

• Cough that lasts more than 1 week

• Fever

• Educate antitussive drugs are for nonproductive coughs

Expectorants

• Liquify lower respiratory tract secretions, reducing the viscosity of these secretions and making it easier for the patient to cough them up

• For a productive cough

• Only available drug: Guaifenesin (Mucinex, Robitussin)

Expectorants Contraindications

Asthma or respiratory insufficiency

Expectorants Nursing Implications

• Drink more or receive more fluids (if permitted) to help loosen and liquify secretions

• Report a fever, increased cough, or other symptoms lasting longer than 1 week

• Red or frothy/foamy secretions should be reported