module 7 continued

Spring Break and Class Updates

  • Announcement about starting spring break early due to class on Friday.
  • Instructor's intention to continuously improve teaching effectiveness.

Inhaled Corticosteroids and COPD Management

  • Correction regarding inhaled corticosteroids (ICS) initially referred to as rescue therapy for COPD.
    • ICS should be viewed as maintenance therapy for COPD when additional help is needed.
    • Comparison: Asthma has maintenance (ICS) and rescue therapies (SABA/SAMA), while COPD traditionally follows a similar model, but with nuanced differences.
    • Key Chart for COPD Management:
    • Maintenance: Long Acting Muscarinic Antagonists (LAMA)
    • Rescue: Short Acting Beta Agonists (SABA) or Short Acting Muscarinic Antagonists (SAMA)
    • Additional therapy: ICS is added during worsening COPD.
  • Summary chart provided through Blackboard for better accuracy.

LABA and LAMA Explanation

  • LABA: Long Acting Beta Agonist vs. LAMA: Long Acting Muscarinic Antagonist.
    • Simplifying terminology: LAMA referred to as anticholinergics or antiparasympathetic agents aiding bronchodilation.
    • Key medications:
    • Ipratropium: Shorter acting compared to tiotropium, used in immediate COPD exacerbation relief and maintenance therapy.
    • Tiotropium: Longer-acting treatment option for COPD.
  • Adverse Effects of Ipratropium and Tiotropium:
    • Dry mouth and hoarseness are common side effects.
    • Special caution required for patients with glaucoma or benign prostatic hyperplasia (BPH).
    • Allergy potential: soy and peanut allergies can affect ipratropium administration.
    • Advice for nurses: always inquire about patient allergies before administering medications.

Use of Systemic Steroids in COPD

  • Systemic steroids may be prescribed when COPD symptoms escalate and inhalers fail to provide relief.
    • Prototype medication: Prednisone.
    • Side Effects of Steroids:
    • Hyperglycemia (especially dangerous in diabetic patients).
    • Fluid retention, edema (especially in heart failure or chronic kidney disease patients).
    • Hypertension risk.
    • Osteoporosis with chronic use.
    • Increased infection risk due to immunosuppression.
    • Adrenal suppression if steroids are stopped abruptly (adrenal glands reduce production of endogenous cortisol).
    • Risk of peptic ulcer due to interaction with NSAIDS.
    • Hypokalemia potential is minimal but noted.

Management of Allergic Rhinitis

  • Seasonal allergies are prevalent, warranting understanding of pharmacological treatments to avoid adverse effects.
  • Key Concept: Allergic Rhinitis
    • Definition: Inflammation of the nasal passages caused by seasonal allergies, featuring symptoms like sneezing and mucus production.
  • Key Types of Hypersensitivity:
    • Type I: Mediated by Immunoglobulin E (IgE).
    • Associated with asthma and allergic rhinitis.
    • Connections made to other types of hypersensitivity:
    • Type II: Immunoglobulin G (IgG) destruction of red blood cells.
    • Type III: Immune complexes causing inflammatory responses.
    • Type IV: Cell-mediated responses, e.g., contact dermatitis.

Antihistamine Therapy for Allergic Rhinitis

  • Prototype: Diphenhydramine (Benadryl), an H1 blocker.
    • Uses in allergic rhinitis, hives, and potential benefits for motion sickness and insomnia.
  • Antihistamine Side Effects:
    • Sedation, dry mouth, constipation, urinary retention.
    • Caution in patients with narrow angle glaucoma, asthma, cardiovascular disease, and in older adults due to risks associated with sedation.
  • Important patient instructions:
    • Avoid alcohol and CNS depressants; maintain adequate hydration.

Nasal Corticosteroids for Allergic Rhinitis

  • Prototype: Mometasone (also Fluticasone).
    • Mechanism: Local application to nasal passages to reduce symptoms of allergic rhinitis.
  • Side Effects Include:
    • Nosebleeds, headaches, throat irritation but not systemic effects like hyperglycemia.
  • Counseling needed for proper daily use as patients may confuse with other steroid treatments.

Decongestants for Allergic Rhinitis

  • Prototype: Phenylephrine, an alpha-adrenergic stimulant.
    • Mechanism: Causes local vasoconstriction to reduce nasal congestion.
  • Adverse Effects Include:
    • Tachycardia, nervousness, anxiety, rebound congestion if used more than three consecutive days.
  • Caution in patients with hypertension or glaucoma; limited duration recommended for use (max 3-5 days).

Cough Management

  • Cough treatments split into two categories:
    1. Antitussives: Suppress the drive to cough.
    2. Expectorants: Facilitate mucus expulsion.

Antitussives

  • Prototype: Hydrocodone as an opioid.

    • Mechanism: Suppress cough reflex from the brain's cortex to the airway.

  • Adverse Effects: Respiratory depression, careful monitoring advised.

  • Alternative: Dextromethorphan.

    • Non-opioid cough suppressor targeting the cough reflex.

  • Cautions for Side Effects:

    • Dizziness, nausea, orthostatic hypotension.
    • Risk of serotonin syndrome, particularly with concurrent use of serotonergic drugs.

Mucolytics and Expectorants

  • Prototype: Guifenesin (Mucinex).

    • Function: Thins mucus and promotes productive cough. Rare adverse effects include GI upset and orthostatic hypotension.

  • Acetylcysteine (N-acetylcysteine) - A mucolytic.

    • Connection to acetaminophen overdose treatment.
    • Breaks down mucus, linked to COPD therapy (beneficial for chronic bronchitis).
    • Cautions: Risk of bronchospasm in asthmatics, nausea, and vomiting possible. Monitor respiratory status.

Conclusion

  • Wrap up of lecture content focused on COPD, allergic rhinitis, and cough management. Importance of understanding each drug's mechanism, indications, contraindications, and side effects emphasized. Doubt-clearing to be conducted regarding topics discussed during the lecture.