pharmacology - respiratory and antibiotics

learning objectives

• identify the classification and actions of respiratory system medications

• identify when, how and to whom respiratory system medications may be administered

• identify the side effects and special considerations associated with respiratory system medications

• identify the considerations and implications of using respiratory system medications across the life

• interpret relevant laboratory tests

the respiratory system

what does it do

• brings oxygen into the body

• removes carbon dioxide

• helps maintain acid base balance

conducting zone

• moves, warms, humidifies and filters air

• nose, pharynx, trachea, bronchi, most bronchioles

respiratory zone

• site of gas exchange

• respiratory bronchioles, alveolar ducts, alveoli

respiratory rates

• < 1 year = 30-60 breaths per minute

• 10 years = 18-30 breaths per minute

• >14 years = 12-18 breaths per minute

common cold

what is it

• viral upper respiratory infection

• usually self-limiting

common findings

• runny/stuffy nose

• sore throat

• headache/body aches

• low grade fever

• malaise

extra caution

• young children, especially with OTC cough/cold medications

treatment

• rest

• fluids

• symptom mangenment

medications

• expectorant - guaifenesin

• decongestant - pseudoephedrine

• antiussive - dextromethorphan

allergies

what is it

• immune response to an allergen

common triggers

• pollen/hay fever

• food

• insect bites/stings

• medications

• environmental allergens

common findings

• sneezing

• runny nose

• itching

• watery eyes

• nasal congestion

treatment

• antihistamine - diphenhydramine, certirizine/ loratadine

• corticosteroid - fluticasone

• systemic corticosteroid - prednisone for severe reactions

worst case scenario

• anaphylaxis

  • life threating

  • emergency

  • may lead to shock

asthma

what is it

• chronic inflammatory airway disorder

• causes reversible bronchoconstriction

common triggers

• dust/ pollen

• pet dander

• smoke

• respiratory infections

• excerise

• stress

• temperature changes

common findings

• cough

• wheezing

• shortness of breath

• chest tightness

severe findings

• significant difficulty breathing

• cyanosis

• confusion or drowsiness

treatment

• SABA - short acting beta agonist

• LABA - long acting beta agonist

• SABA - albuterol

• anticholenergic - ipratropium

• LABA - salmeterol

• corticosteroid - fluticasone

• leukotriene antagonist - montelukast

• xanthine - theophylline

monitoring

• respiratory assessment

• peak flow meter - expiratory rate to monitor asthma

bronchitis

what is it

• ACUTE - usually viral, temporary inflammation of the bronchi

• CHRONIC - chronic productive cough, form of COPD

common triggers

• viral infection

• smoke

• airway irritants

common findings

• cough

• mucous production

• fatigue

• shortness of breath

treatment

• expectorant - guaifenesin

• anticholinergic - tiotropium for chronic bronchitis/COPD

• corticosteroids - prednisone for severe exacerbations

• xanthine - theophylline for chronic COPD when other treatments dont work

ACUTE- manage systems

CHRONIC- long term mangement/ medication

COPD

what is it

• progressive chronic airflow limitation

includes

• emphysema

• chronic bronchitis

common causes

• smoking

• long term irritant exposure

• genetic factors

common findings

• shortness of breath

• chronic cough

• mucous production

• wheezing

• chest tightness

• frequent respiratory infections

• fatigue

• weight loss in advances disease

treatment

• nonpharmacological management

• expectorant - guaifenesine

• anticholinerigc - tiotropium

• corticosteriod - prednisone

• xathine - theophylline

nursing process

assessment

• is it safe to give

• RR

• O2 sat

• lung sounds

• work of breathing

• cough and secretions

planning

• what should improve

implementation

• administer medication correctly

• reinforce inhaler technique

• encourage appropriate breathing strategies

evaluation

• is breathing easier

• are lung sounds improved

• is oxygenation improved

• did the medication cause adverse effects

priority

• always assess respiratory status before and after respiratory medication

diphenhydramine/cetirizine

what is it

• antihistamine

  • diphenhydramine - 1st generation

  • cetirizine / loratadine - 2nd generation

what is it used for

• allergy symptoms

• some cold symptoms

how does it work

• blocks histamine at H1 receptors

• decreases allergic symptoms

what should i watch for

• 1st generation

  • sedation

  • dry mouth

  • constipation

  • urinary retention

  • blurred vision

  • paradoxical SNC stimulation/excitation in kids

• 2nd generation

  • less sedating

  • headache

  • nausea/vomiting

  • fatigue

what should i teach

• take as directed

• avoid alcohol and CNS depressants

• use caution if driving drowsy

priority - 1st generation antihistamines causes more sedation and anticholinergic effects

pseudoephedrine

what is it

• decongestant/ alpha 1 agonist

what is it used for

• nasal congestion

how does it work

• constricts blood vessels in nasal tissues

• decreases swelling and congestion

what should i watch for

• increased heart rate/ dysrhythmias

• increased blood pressure

• nervousness

• insomnia

• headache

• dizziness

use caution

• hypertension

• cardiac disease

• glaucoma

• BPH

• hyperthyroidism

• diabetes

what should i teach

• take only as directed

• do not exceed recommended dose

• avoid with MOAI

• maintain hydration

priority - vasoconstriction clears the nose but can increase blood pressure

dextromethorphan

what is it

• non-opioid antitussive

what is it used for

• dry, hacking, nonproductive cough

• cough interfering with rest/sleep

how does it work

• suppresses cough reflex

• decreases sensitivity of the cough centers/ receptors

what should i watch for

• drowsiness

• nausea

• rash

• difficulty breathing

• hallucinations / disassociation at high doses

• potential misuse

what should i teach

• maintain hydration

• avoid cough irritants

• avoid alcohol and cns depressants

• use caution with MAOis

• use caution of drowsy

benzonatate

what is it

• non-opioid antitussive

what is it used for

• cough associated with respiratory illness

how does it work

• decreases sensitivity of cough receptor

• quiets irraiting cough

what should i watch for

• drowsiness

• dizziness

• constipation

• nausea

• headache

• dry mouth

• rash

• respiratory depression at high doses

what should i teach

• swallow whole

• do no crush, chew, or dissolve

• take with food, if needed for GI upset

• avoid alcohol and CNS depressant

priority - never crush or chew

codeine / guaifenesin

what is it

• opioid antitussive + expectorant

what is it used for

• suppress cough

• loosens muscles

how does it work

• codeine: suppresses the cough reflex

• guaifenesin: thins and loosens mucous

what should i watch for

• sedation

• respiratory depression

• constipation

• nausea/ vomiting

• urinary retention

• abuse/dependence

nursing assessment

• respiratory rate

  • follow ordered respiratory parameters

• respiratory effort

what should i teach

• avoid alcohol and CNS depressants

• do not drive if sedated

• lowest effective dose for the shortest duration possible

priority - respiratory effort

guaifenesin

what is it

• expectorant

what is it used for

• productive cough

• thick respiratory secretions

how does it work

• thins and loosens mucous

• makes secretions easier to cough up

what should i watch for

• nausea/ vomiting

• headache

• rash

• drowsiness

what should i teach

• increases fluids if not contradicted

• avoid respiratory irritants

• avoid alcohol and other CNS depressants

• not safe for all ages

• avoid eating/drinking for 30 minutes after used to encourage cough/deep breathing

priority - gets the mucous out

albuterol/ salmeterol

what is it

• Beta 2 agonist bronchodilators

  • albuterol - SABA (short acting beta agonist)

  • salmeterol - LABA (long acting beta agonist)

what is it used for

• albuterol: rapid relief/ prevention of bronchospasm

  • works in less than 5 minutes

• salmeterol: long-term prevention of bronchospasm

how does it work

• stimulates the beta - 2 receptors

• relaxes bronchial smooth muscle

• opens the airways

what should i watch for

• tremor

• tachycardia

• dysrhythmias

• CNS stimulation

what should i teach

• SABA- short acting beta agonist

• LABA- long acting beta agonist

• prime and shake inhaler as directed

• assess respiratory rate, O2 at, and lung sounds before and after administration

priority: albuterol = rescue, salmeterol = maintenance

ipatropium/ tiotropium

what is it

• anticholinergic bronchodilators

  • ipatropium - short acting

  • tiotropium - long acting

what is it used for

• maintenance treatment of bronchoconstriction

• asthma

• chronic bronchitis

• emphysema/ COPD

how does it work

• block acetylcholine

• relaxes bronchial smooth muscle

• opens airways

what should i watch for

• dry mouth

• constipation

• blurred vision

• dry nasal mucosa

• dizziness

• headache

• angioedema

what should i teach

• take exactly as directed

• do not exceed maximum dose

• report swelling (angioedema)

• both are maintenance drugs (NOT rescue drugs)

• avoid MAOI

priority - cant see, cant shit, cant piss, cant spit

corticosteroids

fluticasone

• inhaled/nasal corticosteroid

used for

• asthma prevention

• nasal inflammation/ allergies

watch

• hoarseness

• sore throat

• oral candidiasis (thrush)

• dry nasal passages

• nosebleeds

teach

• not a rescue inhaler

• rinse mouth after inhaled use

prednisone/ methylprednisolone

• systemic corticosteroid

used for

• severe asthma/ allergic conditions

• acute COPD exacerbations

watch

• increased blood glucose

• fluid retention / edema

• hypernatremia/ hypokalemia

• weight gain (long term)

• hypertension

• mood changes

• GI irratation/ bleeding

• increased infection risk

• delayed wound healing with long term use

teach

• do not stop abruptly after prolonged therapy (blocking immune system from working, so needs time to reactivate)

• report signs of infection

priority - decrease inflammation - they do not provide immediate bronchodilation

MDI teaching

• prime inhaler before first use

• shake inhaler

• exhale

• begin a slow, deep breath (hold 1-2in from mouth)

• press inhaler once while inhaling

• continue inhaling slowly for 2-5seconds

• hold breath for about 5-10 seconds

• exhale slowly

• wait 1-5 minutes between prescribed puffs

if using two different inhalers

• bronchodilators first (opens lungs)

• corticosteroids seconds (sends medication deeper)

why

• opening the airway first helps the second medication reach deeper into the lungs

montelukast

what is it

• leukotriene receptor antagonist

what is it used for

• long term asthma control

• exercise-induced bronchospasm

• allergic rhinitis

how does it work

• blocks leukotriene receptors

• decrease airway inflammation

what should i watch for

• headache

• cough/nasal congestion

• nausea

• liver toxicity

• mental health changes

• suicidal ideation

what should i teach

• take at the same time everyday

• take at least 2 hours before exercise when prescribed for exercise-induced bronchospasm

• do not discontinue without notifying provider

• takes several days for full effect (3-7days)

• not a rescue medication

priority - monitor for serious mood or behavioral changes

theophylline

what is it

• xanthine derivative

what is it used for

• long-term management of chronic asthma/ COPD

• used for other therapies are inadequate (last ditch effort)

how does it work

• relaxes bronchial smooth muscle

• decrease airway response to bronchoconstriction triggers

what should i watch for

• nausea/ vomiting

• nervousness

• insomnia

• CNS stimulation

• toxicity (narrow therapeutic window, 10-20mg/mL)

what should i teach

• not a rescue inhaler

• avoid caffeine (another chemical stimulant)

• maintain hydration

• avoid respiratory irritants

• keep scheduled blood level monitoring (6-12 months)