Pharm Wk 4 Notes
Page 1: Introduction
Overview of various drugs used in respiratory treatment
Antihistamines
Decongestants
Antitussives
Expectorants
Page 2: Understanding the Common Cold
Cause: Viral infections (e.g., rhinovirus, influenza)
Effects:
Virus invades tissues of the upper respiratory tract
Results in upper respiratory infection (URI)
Leads to excessive mucus production and cold symptoms: sore throat, cough, upset stomach
Nasal mucosa irritation triggers sneeze reflex and dilates blood vessels, causing nasal congestion
Page 3: Treatment of the Common Cold
Approach: Symptomatic treatment, not curative
Combined use of:
Antihistamines
Nasal decongestants
Antitussives
Expectorants
Difficulty distinguishing between viral and bacterial causes
Use of antivirals and antibiotics may occur, but diagnosis can be unclear
Page 4: Pediatric Concerns
2008 FDA Recommendation: Avoid OTC cough and cold products in children < 2 years
Risks include:
Oversedation, seizures, tachycardia, death in toddlers
Lack of efficacy in small children
Recommendations for parents to consult pediatricians
Decrease in emergency visits noted after recommendation
Page 5: Antihistamines
Function: Compete with histamine for receptors
Types of Receptors: H1 (allergic reactions), H2 (gastric acid regulation)
Examples of H2 Blockers: Cimetidine, Famotidine, Nizatidine
Page 6: Histamine and Its Effects
Role of Histamine: Major inflammatory mediator in allergies
Outcomes of Release:
Stimulates various secretions (saliva, gastric)
Causes bronchoconstriction, vasodilation, and capillary permeability increase
Page 7: Antihistamine Effects
Antihistamine Action:
Reduces blood vessel dilation & permeability
Anticholinergic effects lead to drying of secretions
Sedative properties present
Page 8: H1 Antagonists
Examples: Chlorpheniramine, Fexofenadine, Loratadine, Cetirizine, Diphenhydramine
Properties include antihistaminic, anticholinergic, and sedative effects
Page 9: Indications for Antihistamines
Treats:
Allergic rhinitis
Allergic reactions
Motion sickness, sleep disorders
Page 10: Contraindications for Antihistamines
Includes:
Known drug allergy
Narrow-angle glaucoma
Cardiac disease, renal issues, asthma, etc.
Page 11: Common Side Effects of Antihistamines
Dry mouth, urinary difficulty, constipation, changes in vision, drowsiness
Page 12: Nonsedating Antihistamines
Goal: Reduce sedation effects
Work peripherally
Examples: Fexofenadine, Loratadine, Cetirizine
Page 13: Traditional Antihistamines
Characteristics: Work both peripherally and centrally, have more anticholinergic effects
Examples: Diphenhydramine, Brompheniramine, Dimenhydrinate
Page 14: Nursing Implications for Antihistamines
Assess condition or allergic history
Use caution with other comorbidities
Page 15: Patient Instructions
Report excessive sedation
Avoid driving; refrain from alcohol consumption
Page 16: Additional Patient Instructions
Take with meals to reduce GI upset
Mouth care for dry mouth
Page 17: Causes of Nasal Congestion
Primary causes include allergies and viral URI
Page 18: Types of Decongestants
Categories: Adrenergics, Anticholinergics, Corticosteroids
Delivery methods: Oral and intranasal
Page 19: Oral Decongestants
Examples: Pseudoephedrine (Sudafed)
Effects are prolonged but less potent
Page 20: Topical Nasal Decongestants
Effectiveness: Prompt and potent
Risk of rebound congestion with prolonged use
Page 21: Intranasal Steroids and Anticholinergic Drugs
Examples: Budesonide, Fluticasone, Ipratropium
Commonly used prophylactically
Page 22: Mechanism of Action for Nasal Decongestants
Constriction of blood vessels in nasal passages reduces swelling and drainage difficulties
Page 23: Indications for Nasal Decongestants
Treat nasal congestion due to various conditions: chronic rhinitis, common cold, sinusitis
Page 24: Contraindications for Nasal Decongestants
Includes drug allergy, uncontrolled cardiovascular disease, hypertension
Page 25: Adverse Effects of Nasal Decongestants
Side effects: Nervousness, insomnia, palpitations
Page 26: Drug Interactions
Likelihood of drug toxicity with concomitant use of sympathomimetics
Page 27: Nursing Implications for Nasal Decongestants
Avoid caffeine; report prolonged symptoms
Page 28: Cough Physiology
The cough reflex clears the respiratory tract of secretions and foreign objects
Page 29: Types of Cough
Productive: removes excessive secretions
Nonproductive: dry cough; usually less beneficial
Page 30: Antitussives Overview
Medications that suppress or reduce coughing; used primarily for nonproductive coughs
Page 31: Antitussives Mechanism of Action
Opioids: Suppress cough by acting on the brain's cough center; analgesic effects
Page 32: Nonopioid Antitussives Mechanism
Suppress the cough reflex without CNS depression, e.g., Dextromethorphan
Page 33: Antitussives Indications
For nonproductive or harmful coughs
Page 34: Antitussives Contraindications
Allergy, opioid dependency, and respiratory depression
Page 35: Common Antitussive Drugs
Benzonatate, Dextromethorphan, Opioids; note side effects
Page 36: Nursing Implications for Antitussives
Monitor patient for drowsiness and report serious symptoms
Page 37: Expectorants Overview
Drugs that aid in mucus removal; decrease viscosity of secretions, e.g., Guaifenesin
Page 38: Mechanism of Action for Expectorants
Reflex stimulation or direct stimulation of secretory glands to thin mucus
Page 39: Expectorants Indications
Used for productive cough relief in various respiratory conditions
Page 40: Nursing Implications for Expectorants
Use caution in older adults; increase fluid intake if possible
Page 41: Overview respiratory drugs
Main function is oxygen delivery and CO2 removal from cells
Page 42: Diseases of Lower Respiratory Tract
Includes COPD, asthma, emphysema, and chronic bronchitis
Page 43: Pharmacologic Overview
Bronchodilators: Relax bronchial smooth muscle
Classes: Beta-adrenergic agonists, anticholinergics, xanthine derivatives
Page 44: Bronchodilators - Beta-Adrenergic Agonists
SABAs: Rescue inhalers
LABAs: Maintenance therapy, not for acute treatment
Page 45: Types of Beta-Adrenergic Agonists
Examples: Epinephrine, Albuterol, and others
Page 46: Mechanism of Action for Beta-Adrenergic Agonists
Activation of beta2 receptors leads to dilation of airways
Page 47: Indications for Beta-Adrenergic Agonists
Treat bronchospasm in asthma, bronchitis, lung diseases
Page 48: Contraindications for Beta-Adrenergic Agonists
Known drug allergy, uncontrolled hypertension, cardiac dysrhythmias
Page 49: Common Side Effects of Beta-Adrenergic Agonists
Insomnia, restlessness, hyperglycemia, tremors
Page 50: Interactions with Beta-Adrenergic Agonists
Monitor patients with diabetes; increased blood glucose possible
Page 51: Albuterol (Proventil)
Most common SABA; use with caution to avoid frequent use
Page 52: Salmeterol (Serevent)
Long-acting beta2 agonist; prescribed for maintenance, not for acute treatment
Page 53: Nursing Implications for Beta-Adrenergic Agonists
Report symptoms of excessive stimulation; monitor for therapeutic effects
Page 54: Anticholinergic Mechanism of Action
Block acetylcholine, preventing bronchoconstriction
Help reduce secretions in COPD
Page 55: Anticholinergic Side Effects
Include dry mouth, palpitations, GI distress
Page 56: Anticholinergic Drugs Example
Ipratropium (Atrovent) and others
Page 57: Xanthine Derivatives Overview
Plant-derived compounds; includes theophylline
Page 58: Mechanism of Action for Xanthine Derivatives
Inhibit phosphodiesterase, increasing smooth muscle relaxation
Page 59: Xanthine Derivatives Effects
Cause bronchodilation and a diuretic effect
Page 60: Indications for Xanthine Derivatives
Treat asthma, chronic bronchitis, and emphysema
Page 61: Side Effects of Xanthine Derivatives
Nausea, tachycardia, hyperglycemia
Page 62: Theophylline Use
Typically for status asthmaticus; careful monitoring required
Page 63: Nursing Implications for Xanthine Derivatives
Report side effects to prescriber; assess for interactions
Page 64: Caffeine's Role
Increase respiratory drive in infants; CNS stimulant
Page 65: Non-Bronchodilating Respiratory Drugs
Includes leukotriene receptor antagonists and corticosteroids
Page 66: Leukotriene Receptor Antagonists
Used in asthma management; prevent allergic reactions
Page 67: Mechanism of Action for LTRAs
Blocks receptors, thus reducing inflammation and mucus production
Page 68: Adverse Effects of LTRAs
Headaches, nausea; potential behavioral changes
Page 69: Nursing Implications for LTRAs
Assess liver function; reinforcement on continuous use
Page 70: Corticosteroids Overview
Antiinflammatory; used for chronic asthma treatment
Page 71: Corticosteroids Mechanism of Action
Stabilize cell membranes and increase responsiveness to beta agonist therapy
Page 72: Inhaled Corticosteroids
May take weeks for full effect; indicated for bronchospastic disorders
Page 73: Contraindications for Inhaled Corticosteroids
Drug allergy; not for acute asthma treatment
Page 74: Side Effects of Corticosteroids
Oral infections, irritation; systemic effects rare due to dosing
Page 75: Drug Interactions of Corticosteroids
Monitoring sugar levels in diabetes; potential interactions with other medications
Page 76: Nursing Implications for Inhaled Corticosteroids
Oral care to prevent fungal infections; instruction on inhaler use
Page 77: General Nursing Implications
Encourage adherence to therapies and report adverse effects