Respiratory Medications

Antihistamines Action

Histamine (H1) receptor Antagonist

__**Decongestants**__ Sympathoomimetics’ Action

Alpha1 Agonist - nasal vasoconstriction

Intranasal Glucocorticoid Action

anti-inflammatory

Antitussives Action

Cough suppressant → CNS suppression of cough

Expectorant Action

Promotes respiratory tract secretion removal

Antivirals Action

inhibiting neuraminidase

Anti-tubercular Action

depends on the type of tuberculosis

Four Examples of Antihistamines

• Azelastine aka Astelin

• Oloparadine aka Patanase

• Loratadine aka Claritin

• Diphenhydramine aka Benadryl

Azelastine aka

Astelin

Oloparadine aka

Patanase

Loratadine aka

Claritin

Diphenhydramine aka

Benadryl

Indications of Use for Azelastine and/or Olopatadine

Allergic Rhinitis

Indications of Use for diphenhydramine

• couch

• allergic rhinitis

Side Effects of Azelastine and/or Olopatadine

• Epistaxis

• Headache

Nursing Implications for Azelastine and/or Olopatadine

• Nasal Spray

• Non-Sedating

• Unpleasant Taste

Nursing Implications of Loratadine

• Oral

• Non-Sedating

• Best taken Prophylactically

Loratadine aka

Claritin

Side Effects of Diphenhydramine

• Sedation

• Dry Mouth

• Constipation

phenylephrine aka

Neo Synephrine

Is phenylephrine long or short acting?

Short Acting

Pseudophedrine aka

Sudafed

Oxymetazoline is aka

Afrin

Is Oxymetazoline long or short acting?

Long Acting

Medications under the decongestant sympathomimetics class

• Phenylephrine

• Pseudoephedrine

• Oxymetazoline

• Ephedrine

Indications of Use for the Decongestant Sympathomimetics drug class

• Allergic Rhinitis

• URI

CNS Side Effects of Decongestant Sympathomimetics

in oral meds:

• Restlessness

• Irritability

• Anxiety

• Insomnia

C-V Side Effects of Decongestant Sympathomimetics

Possible side effects in Oral Meds

* Use w/ caution in pts w/ CAD and HTN, etc…

Respiratory Side Effects of Decongestant Sympathomimetics

Rebound congestion with topical agents (nasal spray) → can cause a negative cycle (limit use to 3-5 days)

What forms can Decongestant Sympathomimetics be found in?

• oral

• nasal

• spray

Nursing Implications for Oral Decongestant Sympathomimetics

Pseudoephedrine and ephedrine A/W abuse → methamphetamine production → behind the counter at store to reduce access

Medication Example of Intranasal Glucocorticoid Drug Class

Beclomethasone

Beclomethasone aka

Beconase

Indications of Use for Beclomethasone

Allergic Rhinitis

Side Effects of Beclomethasone

• drying of nasal mucosa leading to itching or burning

• sore throat

• epistaxis

• headache

Nursing Implications for Beclomethasone

Systemic effects possible with high dose, esp. in children (adrenal suppression

Examples of Medications in the Antitussive Drug Class

• Hydrocodone → opioid

• Codeine → opioid

• Dextromethorphan (DM) → nonopiod

Indications of Use for Antitussives

Cough

Side Effects for Antitussive Use

• Respiratory Depression

• Euphoria → esp. in high doses of DM

Nursing Implications for Antitussives Opioids:

• potential of abuse

• Naloxone is the opioid antagonist

Nursing Implications for Antitussives Non-Opioids like DM

Can be abused for its CNS effects in very large doses

Dextromethorphan is aka

DM

Example of Medication in the Expectorant Drug Class

Guaifenesin

Guaifenesin aka

Mucinex

Indications for Use of Guaifenesin

* URI/LRI

Side Effects to Guaifenesin

\*few

Example of Medication in the AntiViral Drug Class

• Oseltamivir

• Zanamivir

• Peramivir

Oseltamivir aka

Tamiflu

Zanamivir aka

Relenza

Peramivir aka

Rabivab

Indication of Use for Oseltamivir, Zanamivir, and Peramivir?

Influenza

Methods + Side Effects for the listed influenza antivirals

• Oral

• Inhalation → Throat Irritation

• IV

Nursing Implications for the listed influenza antivirals

Within 24 hours of symptoms, shorten the duration of the illness

Ex: Of Influenza Vaccines

• Trivalent Inactivated Influenza Vaccine (TIIV)

• Live Attenuated (weakened) Influenza Vaccine → LAIV3

• FluMist → newer quadrivalent live attenuated influenza vaccine soon (LAIV4)

Indications for Use for the Influenza Vaccine

Annual Vaccination

Side Effects of the Influenza Vaccine

• Soreness at the site of injection

• H/A

• Sore Throat

• Cough

• Runny Nose

How is the influenza vaccine administered?

• Flu shot for 6 months and older

• Nasal Spray in healthy and non-pregnant individuals 2 years to 49 years

Who should be cautioned when taking the Influenza vaccine?

• People with allergy/sensitivity to chicken eggs

• In people w/ Hx of GBS

When should a person defer the influenza vaccination?

When they have acute afebrile illness

Examples of Anti-Tubercular Medications

• Isoniazid

• Rifampin

• Pyrazinamide

• Myambutol

Isoniazid aka

Nydrazid, INH

Rifampin aka

Rifadin

Pyrazinamide aka

PZA

Ethambutol aka

Myambutol

Indication for Use of Isoniazid

M. Tuberculosis

Indication for Use of Rifampin

M. Tuberculosis and Leprosy

Indication for Use of Pyrazinamide

M. Tuberculosis

Indication for Use of Ethambutol

M. Tuberculosis

MOA for Isoniazid

Exact mechanism unknown, thought to suppress mycolic acid synthesis in cell wall

MOA for Rifampin

Suppresses RNA synthesis → protein synthesis

MOA for Pyrazinamide

Unknown

MOA FOR Ethambutol

• Bacteriostatic

• Suppresses bacterial wall growth

Side Effects of Isoniazid

• Hepatotoxicity

• Peripheral neuropathy – paresthesias of hands and feet

• Rash

• Fever

Side Effects for Rifampin

• Hepatotoxicity

• Fever

Side Effects for Pyrazinamide

• Hepatotoxicity

• Non-gouty polyarthralgia

Visual Side Effects for Ethambutol

Optic neuritis → blurred vision, lack of color discrimination

\

Integumentary Side Effects for Ethambutol

• dermatitis

• pruritus

T/F? Confusion is a side effect for Ethambutol

True

Nursing Implications for Isoniazid

• Should be taken by everyone with TB infection

• *If neuropathy occurs, will take pyridoxine po daily

• *Avoid alcohol ingestion

DRUG-DRUG Interaction w/ Isoniazid

\*Drug-drug interactions: phenytoin

When should Isoniazid be given?

before meals

Nursing Implications for Rifampin

\*Orange discoloration of body fluids – tears, sweat, urine

When should Rifampin be taken?

Take on empty stomach

DRUG-DRUG Interaction w/ Rifampin

oral contraceptives, warfarin, and some protease inhibitors

Nursing Implications of Pyrazinamide

• Used in combo w/ other drugs

• Liver Function Tests

Nursing Implications for Ethambutol

• Can be used if resistant to INH and/or Rifampin

• *Usually used after other drugs

• Use cautiously with renal disease

Example of DVT Prophylaxis Medication

Enoxaparin

Enoxaparin aka

Lovenox

Indications for Use of Enoxaparin

• DVT Prophylaxis

• DVT Treatment

• Unstable Angina

MOA of Enoxaparin

• Low-Molecular-Weight Heparin (LMWH)

• Anticoagulant → Inactive Factor Xa

Side Effects of Enoxaparin

• Bleeding

• Thrombocytopenia

• Neurologic Injury in those w/ recent spinal puncture

How often is Enoxaparin prescribed?

Daily or BID

Enoxaparin Form

SubQ

How is Enoxaparin dosage calculated?

Weight

Nursing Implications of Enoxaparin

• Patients are taught self-administration

• *Pre-filled syringe system. Do not remove small air bubble.

• *Administer in outer abdomen – “love handles”

Example of Methylxanthine Classification Medication

Theophylline

Theophylline aka

• Theo-Dur

• Slo-bid

etc…

Indication of Use for Theophylline

Chronic Stable Asthma

MOA for Theophylline

• Relaxation of bronchial smooth muscle

• Improved Diaphragm Function

Side Effects of Theophylline

• CV: tachycardia, BP changes, arrhythmias

• Nausea

• Nervousness