Week 5: Drugs Affecting the Respiratory System

Introduction to Allergic Rhinitis

Definition:

• Chronic inflammatory condition of the nasal mucosa

Common Allergens:

• Pollen

• Dust mites

• Pet dander

• Mold

Pathophysiology:

• IgE-mediated immune response leading to inflammation and symptoms like sneezing, itching, and nasal congestion

Causes of Nasal Congestion

Definition:

• Blockage or obstruction of the nasal passages

Common Causes:

• Viral infections (e.g., common cold)

• Bacterial infections (e.g., sinusitis)

• Allergies

• Environmental irritants (e.g., smoke, pollution)

Mechanism:

• Swelling of nasal tissues due to inflammation and increased mucus production

Rhinitis Medicamentosa

Definition:

• Rebound nasal congestion caused by overuse of topical nasal decongestants

Causes:

• Prolonged use of decongestant sprays (e.g., oxymetazoline, phenylephrine)

Symptoms:

• Persistent nasal congestion, dependency on nasal sprays

Sympathomimetic Medications - Actions

Definition:

• Drugs that mimic the effects of the SNS

Mechanism:

• Vasoconstriction of nasal blood vessels → reducing blood flow and swelling in the nasal passages

Examples:

• Pseudoephedrine

• phenylephrine

“not as effective for HTN, would increase BP; not good for HF”

“not specifically only effect nasal (effects rest of body too)”

“main ingredient = amphetamines”

Examples of Sympathomimetic Medications

• Pseudoephedrine

• phenylephrine

What is the mechanism of Sympathomimetic Medicines?

Vasoconstriction of nasal blood vessels → reducing blood flow and swelling in the nasal passages

Sympathomimetic Medicines - Adverse Effects

Common Adverse Effects:

• Increased BP

• Insomnia

• Nervousness

• Dizziness

Serious Adverse Effects:

• Arrhythmias

• Palpitations

Nursing Considerations:

• Monitor BP and HR

• Educate patients on proper use and potential side effects

Antihistaminic Medicines - Actions

Definition:

• Drugs that block histamine receptors to reduce allergic symptoms

Examples:

• diphenhydramine (Benadryl)

• loratadine

• cetirizine (Zyrtec)

Mechanism:

• Block H1 receptors, preventing histamine from binding and causing symptoms like itching, sneezing, and runny nose

Examples of Antihistaminic Medicines

• diphenhydramine (Benedryl)

• loratadine

• cetirizine (Zyrtec)

Antihistaminic Medications - Adverse Effects

Common Adverse Effects:

• Drowsiness

• Dry mouth

• Blurred vision

• Urinary retention

Serious Adverse Effects:

• Severe allergic reactions

• Confusion (especially in elderly patients)

  • “usually diphenhydramine (benadryl)”

Nursing Considerations:

• Monitor for drowsiness and educate patients on avoiding activities requiring alertness, such as driving

Corticosteroid Medicines - Actions

Definition:

• Anti-inflammatory drugs used to treat allergic rhinitis and nasal congestion

Mechanism:

• Reduce inflammation by inhibiting multiple inflammatory pathways, decreasing swelling and mucus production

Examples:

• fluticasone

• budesonide

• mometasone

Examples of Corticosteroid Medicines

• fluticasone

• budesonide

• mometasone

What is the mechanism of Corticosteroid Medicines?

Reduce inflammation by inhibiting multiple inflammatory pathways, decreasing swelling and mucus production

Corticosteroid Medicines - Adverse Effects

Common Adverse Effects:

• Nasal irritation

• Headache

• Nosebleeds

Serious Adverse Effects:

• Adrenal suppression

• Growth retardation in children (with long-term use)

Nursing Considerations:

• Educate patients on proper administration techniques to minimize side effects

• Monitor for signs of systemic absorption

Decongestants and Hypertension

Caution:

• Decongestants can increase BP

Mechanism:

• Vasoconstriction leading to increased peripheral resistance

  • “activates SNS”

Nursing Considerations:

• Monitor BP

• Advise patients with hypertension to use decongestants cautiously and under medical supervision

Decongestants and Hyperthyroidism

Caution:

• Decongestants can exacerbate symptoms of hyperthyroidism

Mechanism:

• Increased metabolic rate and sympathetic activity

Nursing Considerations:

• Monitor thyroid function

• Educate patients on potential risks

Decongestants and Diabetes Mellitus

Caution:

• Decongestants can affect blood glucose levels

Mechanism:

• Sympathomimetic effects can increase blood glucose

Nursing Considerations:

• Monitor blood glucose levels

• Advise patients to consult with their healthcare provider before use

Decongestants and Cardiac Disease

Caution:

• Decongestants can increase cardiac workload

Mechanism:

• Increased HR and BP

Nursing Considerations:

• Monitor cardiac function

• Educate patients on potential risks

Decongestants and Increased Intraocular Pressure

Caution:

• Decongestants can increase intraocular pressure

Mechanism:

• Vasoconstriction affecting ocular blood flow

Nursing Considerations:

• Monitor intraocular pressure

• Advise patients with glaucoma to use decongestants cautiously

Decongestants and Prostatic Disease

Caution:

• Decongestants can cause urinary retention

Mechanism:

• Sympathomimetic effects on the bladder neck and prostate

Nursing Considerations:

• Monitor urinary function

• Educate patients on potential risks

Nursing Assessments During Decongestant Therapy

Therapeutic Response:

• Assess effectiveness of therapy (e.g., relief of nasal congestion)

Common Adverse Effects:

• Monitor for side effects, such as increased BP, insomnia, and nervousness

Serious Adverse Effects:

• Monitor for severe reactions, like arrhythmias and palpitations

Monitoring Therapeutic Response

Assessment:

• Regularly assess symptom relief and overall patient condition

Documentation:

• Keep accurate records of patient responses and any adverse effects

Patient Feedback:

• Encourage patients to report their experiences and any side effects

Common Adverse Effects

Identification:

• Recognize common side effects of decongestants, antihistamines, and corticosteroids

Management:

• Provide strategies to manage side effects (e.g., hydration for dry mouth, rest for drowsiness)

Patient Education:

• Inform patients about what to expect and how to manage side effects

Serious Adverse Effects

Identification:

• Recognize serious side effects that require immediate attention

Management:

• Develop a plan for managing serious adverse effects (e.g., emergency protocols for arrhythmias)

Patient Education:

• Educate patients on recognizing serious side effects and when to seek medical help

Nursing Assessments for Respiratory Status

Inspection:

• Observing chest movement and symmetry

• Noting the use of accessory muscles

• Checking skin color for cyanosis

Palpation:

• Assessing for tenderness or masses

• Evaluating tactile fremitus

Percussion:

• Identifying areas of resonance or dullness

Auscultation:

• Listening for breath sounds (e.g., wheezes, crackles, stridor)

Vital Signs in Respiratory Assessment

Respiratory Rate:

• Normal range (12-20 breaths per minute for adults)

• Identifying tachypnea or bradypnea

Oxygen Saturation:

• Importance of SpO2 monitoring (normal range: 95-100%)

  • “Post-COVID now 92-100%”

• Recognizing hypoxemia

HR and BP:

• Relationship with respiratory status

• Monitoring for changes during respiratory distress

Mechanisms of Action: Expectorants

Definition:

• Medications that help expel mucus from the respiratory tract

Example:

• guaifenesin (Mucinex)

Mechanism:

• Increasing bronchial secretion

• Reducing mucus viscosity to facilitate expulsion

“commonly used for pneumonia”

Example of Expectorant

guaifenesin (mucinex)

Mechanisms of Action: Antitussives

Definition:

• Medications that suppress coughing

Examples:

• dextromethorphan

• codeine

Mechanism:

• Acting on the cough center in the brain to reduce the cough reflex

“not commonly given b/c you want them to cough stuff out”

“given for dry cough sometimes to help patients sleep"

Examples of Antitussives

• dextromethorphan

• codeine

Mechanisms of Action: Mucolytic Agents

Definition:

• Medications that break down mucus

Example:

• acetylcysteine

Mechanism:

• Breaking down the chemical structure of mucus to make it less viscous

“usually hospital given, lots of s/e, needs to be monitored”

Example of Mucolytic Agents

acetylcysteine

Beta-Adrenergic Bronchodilators - Actions

Definition:

• Medications that relax bronchial smooth muscle

Examples:

• albuterol

• salmeterol

Mechanism:

• Stimulating beta-2 receptors in the lungs

• Resulting in bronchodilation and improved airflow

“beta blocker could counter effects of this drug, has opposite effect of beta blockers”

“use w/caution for asthma patients”

Examples of Beta-Adrenergic Bronchodilators

• albuterol

• salmeterol

Beta-Adrenergic Bronchodilators - Adverse Effects

Common Adverse Effects:

• Tremors

• Palpitations

• Headache

Serious Adverse Effects:

• Tachycardia

• Arrhythmias

Nursing Considerations:

• Monitoring HR and BP

• Educating patients on proper use and potential side effects

Nursing Assessments for Beta-Adrenergic Therapy

Assessment:

• RR and effort before and after administration

Monitoring:

• HR and BP for changes

Evaluation:

• Patient response to therapy (e.g., improved airflow)

Anticholinergic Bronchodilators - Actions

Definition:

• Medications that prevent bronchoconstriction

Examples:

• ipratropium

• tiotropium

Mechanism:

• Blocking acetylcholine receptors in the lungs

• Resulting in bronchodilation and reduced mucus production

Examples of Anticholinergic Bronchodilators

• ipratropium

• tiotropium

Anticholinergic Bronchodilators - Adverse Effects

Common Adverse Effects:

• Dry mouth

• Cough

• Headache

Serious Adverse Effects:

• Urinary retention

• Increased intraocular pressure

Nursing Considerations:

• Monitoring for signs of dry mouth and urinary retention

• Educating patients on proper use and potential side effects

Nursing Assessments for Anticholinergic Therapy

Assessment:

• RR and effort before and after administration

Monitoring:

• Signs of dry mouth and urinary retention

Evaluation:

• Patient response to therapy

Corticosteroid Inhalants - Actions

Definition:

• Medications that reduce inflammation in the airways

Examples:

• fluticasone

• budesonide

Mechanism:

• Reducing inflammation and swelling in the airways

• Resulting in decreased airway hyper-responsiveness and improved breathing

Examples of Corticosteroid Inhalants

• fluticasone

• budesonide

Corticosteroid Inhalants - Adverse Effects

Common Adverse Effects:

• Oral thrush

  • “increased blood sugar from corticosteroids → bacteria grow”

• Hoarseness

Serious Adverse Effects:

• Adrenal suppression

• Growth retardation in children (with long-term use)

Nursing Considerations:

• Monitoring for signs of oral thrush and hoarseness

• Educating patients on proper inhaler technique and rinsing mouth after use

Nursing Assessments for Corticosteroid Therapy

Assessment:

• RR and effort before and after administration

Monitoring:

• Signs of oral thrush and hoarseness

Evaluation:

• Patient response to therapy