Upper Respiratory Disorders

upper airway meds purpose

work on CNS/nasal passages/resp system to treat allergic + nonallergic rhinitis/coughs from common cold/influenza/etc

Antihistamines

for allergic rhinitis/nausea/motion sickness/allergic rxn/insomnia (have a sedative effect)

an antitussive is combined with an expectorant to

Reduce a cough

upper respiratory meds - AEM DAN

antitussives (opioids/nonopioids), expectorants, mucolytics, decongestants, antihistamines, nasal glucocorticoids

Opioid Antitussives

Hydrocodone

Codeine

expected pharmacological action of opioid antitussives

decrease frequency/intensity of chronic nonproductive cough thru action on CNS

complications of opioid antitussives

CNS effects (dizziness/lightheadedness/drowsiness/resp depression - stop if RR <12/min, adm naloxone), GI distress (nausea/vomiting/constipation - take PO codeine w food, increase fluids/fiber), opioid use disorder (use 4 short duration)

Contraindictions/Precautions of Opioid Antitussives

preg risk C, codeine alone SCH II/codeine mixed SCH V, contra resp depress/acute asthma/head trauma/liver + renal dysfunction/acute alc use disorder, cautious children/older adults/substance use disorder

While taking codeine, Avoid

Activities requiring alertness + Alc/CNS Depressants

non-opioid antitussives

Dextromethorphan (in many products for cough)
Benzonatate (Tessalon Pearls)
Diphenhydramine (Benadryl)

expected pharmacological action of non-opioid antitussives

suppresses cough thru action on CNS + reduces pain when combined w/ opioid

complications of non-opioid antitussives

mild nausea/dizziness/sedation, potential abuse for euphoria from high doses

contraindications/precautions of non-opioid antitussives

dextromethorphan/benzonatate preg risk C, diphenhydramine preg risk B

interactions of non-opioid antitussives

high fever when used within 2 wks of MAOI antidepressants

available forms of non-opioid antitussives

capsules, lozenges (12 yr+), liquids, syrups

some formulations of non-opioid antitussives can contain

Alcohol/Sucrose

expectorants

Guaifenesin (Mucinex)

expected pharmacological action of expectorants

increase cough production by increasing/thinning mucous secretions - often combined w antitussives + decongestant

complications of expectorants

GI upset, drowsiness/dizziness, allergic rxn (rash)

contraindications/precautions of expectorants

preg risk C/cautious lactation, cautious asthma bc guaifenesin can cause bronchospasm, contra for children depending on form/med combos

report cough lasting longer than

1 wk to provider

take doses of guaifenesin with

full glass water + continue fluid intake

mucolytics

Acetylcysteine (Mucomyst): INH
Hypertonic saline

expected pharmacological action of mucolytics

thin + enhance flow of secretions in resp passages - treat acute/chronic pulmonary disorders/cystic fibrosis

what is the antidote for acetaminophen poisoning?

acetylcysteine: PO/IV

complications of mucolytics

aspiration/bronchospasm when adm PO, dizziness/drowsiness/hypotension/tachycardia, hepatotoxicity

contraindications/precautions of mucolytics

preg risk B, cautious hypothyroidism/CNS depression/renal + liver disease/seizure disorders/asthma bc risk bronchospasm

acetylcysteine has an odor that smells like

rotten eggs

decongestants

Phenylephrine
Ephedrine
Pseudoephedrine (Sudafed)

expected pharmacological action of decongestants

stimulate alpha 1 adrenergic receptors to reduce inflammation of nasal membranes

complications of decongestants

rebound congestion (use 3-5 days), CNS stimulation (agitation/nervousness/uneasiness), vasoconstriction

contraindications/precautions decongestants

preg risk C, contra closed angle glaucoma, cautious CAD/HTN/CVA/dysrhythmias

when adm nasal drops, place client in ___________ position to increase effect + prevent swallowing med

Lateral head-low

_______ are preferred for children for precise adm/prevent toxicity

Drops

pseudoephedrine/ephedrine are non prescription but must be purchased with

Identification

topical VS oral agents

TOP more effective/work faster/shorter duration but worry for rebound congestion - PO worry for vasoconstriction/CNS stimulation

1st gen H1 antagonists - for inflammation/motion sickness (DPD_

Diphenhydramine (Benadryl)
Promethazine (Phenergan)
Dimenhydrinate (Dramamine)

2nd gen H1 antagonists - for seasonal allergies (LCFD)

Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Desloratadine (Clarinex)

intranasal antihistamines (AO)

Azelastine
Olopatadine

expected pharmacological action of antihistamines

relieve itching/sneezing/rhinorrhea (not congestion) - 1st gen produces cholinergic effects/drowsiness

complications of antihistamines

sedation, anticholinergic effects (maintain 2-3 L water), GI discomfort, acute toxicity/excitation/hallucinations/incoordination/seizures in children, resp. depress/local tissue injury at IV site (IM adm preferred or thru large bore IV in <25 mg/mL)

symptoms of acute toxicity/excitation/hallucinations/incoordination/seizures in children

flushed face, high fever, tachycardia, dry mouth, urinary retention, pupil dilation (adm activated charcoal/catharic to decrease abs, acetaminophen for fever, ice packs/sponge bath)

contraindications/precautions of antihistamines

contra 3rd trimester/breastfeeding/newborns (sensitive to sedation), cautious children/older adults (sensitive to resp. depress)

interactions of antihistamines

alc/CNS depressants (opioids/barbiturates/benzodiazepines) cause additive CNS depression

if taking 1st gen antihistamines, be aware of

sedating effects

nasal glucocorticoids - MFTB

Mometasone (Nasonex)
Fluticasone (Flonase)
Triamcinolone (Nasacort)
Budesonide (Rhinocort)

expected pharmacological action of nasal glucocorticoids

decrease inflammation associated w/ allergic rhinitis, 1st line treatment nasal congestion + help sinusitis

complications of nasal glucocorticoids

sore throat, nosebleed, headache, burning in nose

contraindications/precautions of nasal glucocorticoids

budesonide preg risk B/all others preg risk C

adm nasal glucocorticoids

with metered-dose spray daily

seasonal allergic rhinitis can take ____ days to get max relief

7+

perennial allergic rhinitis can take _____ days to get max relief

2+

clear blocked nasal passages with a ________ prior to nasal glucocorticoid adm

Topical Decongestant