Chapter 38 Respiratory Drugs

Page 2: Chapter 38 - Upper Respiratory Disorders

Summary

• Focus on upper respiratory disorders and their pharmacological treatments.

Page 3: Upper Respiratory Disorders

Upper Respiratory Disorders

What are they?

• Illnesses affecting the nose, sinuses, and throat

• Caused by viruses or bacteria

Common Disorders & Symptoms

1⃣ Common Cold – Caused by rhinovirus, affects nose/throat, symptoms: runny nose, cough, mild fever
2⃣ Acute Rhinitis – Nasal inflammation, symptoms: stuffy nose, sneezing, itchy eyes
3⃣ Sinusitis – Sinus inflammation, symptoms: headache, facial pain, congestion
4⃣ Acute Pharyngitis – Throat inflammation, symptoms: sore throat, trouble swallowing, fever

🔹 Key Point: All involve inflammation; treatment depends on the cause (virus vs. bacteria).

Page 4: Antihistamines

What are Antihistamines?

• Block histamine (H1 receptors) to reduce allergy and cold symptoms

• Used for runny nose, sneezing, itching, watery eyes

Types of Antihistamines

1⃣ First-Generation (Older, More Side Effects)

• Examples: Diphenhydramine (Benadryl)

• Effects: More drowsiness, dry mouth, dizziness (anticholinergic effects)

2⃣ Second-Generation (Newer, Fewer Side Effects)

• Examples: Cetirizine, Loratadine, Fexofenadine

• Effects: Less drowsiness, fewer anticholinergic effects

• 🔹 Key Point: First-gen antihistamines make you sleepy 💤, while second-gen are non-drowsy and better for daily use.

Page 5: Diphenhydramine

What is it?

• First-generation antihistamine (causes drowsiness)

• Blocks histamine to stop allergy & cold symptoms

🔹 Uses

✔ Allergic reactions (rhinitis, hives, itching)
✔ Common cold (sneezing, cough)
✔ Motion sickness prevention

🚫 Contraindications (Who Should Avoid It?)

❌ Closed-angle glaucoma (can increase eye pressure)
❌ Urinary retention (can make it worse)
❌ Severe liver disease

⚠ Interactions

• Increases drowsiness with alcohol and other CNS depressants (e.g., sleeping pills, opioids)

🔹 Key Point: Diphenhydramine = Drowsy 💤 & avoid alcohol 🚫🍷

Page 6: Clinical Judgment for Diphenhydramine

Concept

Concept: Gas Exchange

• Diphenhydramine affects breathing & secretions

• Must monitor respiratory function carefully

🔎 Recognizing Cues (Assessment)

✔ Check environmental exposure (allergens, dust, pollen)
✔ Assess urinary function (risk of retention)
✔ Monitor heart & lung status (breathing, heart rate)

Analyze Cues

Analyzing Cues & Prioritizing Hypothesis

• Risk: Hypoxemia (low oxygen) from excessive mucus

• Main Issue: Decreased gas exchange due to congestion

Generate Solutions

✅ Generating Solutions (Goals)

✔ Patient will have less nasal congestion
✔ Mucosal secretions & cough will decrease
✔ Improved breathing & comfort

Page 7: Action Plan for Diphenhydramine

Taking Action (Nursing Interventions)

✔ Monitor respiratory rate & effort – Watch for breathing issues
✔ Encourage fluids – Helps thin mucus & prevent dry mouth
✔ Assess urinary output – Prevents retention issues
✔ Educate patient – Avoid alcohol, caution with driving
✔ Monitor for drowsiness – Fall risk, especially in elderly

📊 Evaluating Outcomes

✅ Patient reports improved breathing
✅ Nasal congestion & coughing decrease
✅ No signs of severe drowsiness or urinary retention

🔹 Key Point: Monitor breathing, encourage fluids, and educate on drowsiness risks! 💨💧💤

Page 8: Nasal and Systemic Decongestants

What Are They?

• Stimulate alpha-adrenergic receptors → Nasal blood vessels constrict

• Effect: Shrinks swollen nasal tissues & reduces mucus production

• Relieve nasal congestion by shrinking swollen blood vessels in the nose

• Used for common cold, allergic rhinitis, sinusitis

• Forms Available

  • Nasal spray/drops (quick relief)

  • Tablets, capsules, liquids (longer-lasting effects)

💊 Uses

✔ Allergic rhinitis
✔ Nasal inflammation
✔ Nasal infections

• Allergic rhinitis: A common condition that causes sneezing, itching, and nasal congestion due to allergens.

• Nasal inflammation: Swelling of the nasal passages often linked to allergies or infections.

• Nasal infections: Conditions such as sinusitis that can lead to pain, pressure, and further respiratory issues.

💊 Common Nasal Decongestants

✔ Oxymetazoline (Afrin)
✔ Phenylephrine
✔ Pseudoephedrine (Sudafed)

⚠ Side Effects & Risks

• Nervousness, restlessness, increased heart rate (tachycardia)

• Rebound congestion (if used too long)

Nursing Considerations

✔ Limit use to 3-5 days to prevent rebound congestion
✔ Monitor blood pressure (can increase BP)
✔ Avoid in patients with hypertension & heart disease

🔹 Key Point: Short-term use only! Overuse = worse congestion 🚫👃

Page 9: Side Effects of Decongestants

⚠ Side Effects

💓 Increased heart rate (tachycardia)
📈 High blood pressure (hypertension)
😰 Nervousness, restlessness
👃 Rebound congestion (if overused)

🚫 Drug Interactions (Be Careful With These!)

❌ Beta blockers – Decongestants can reduce their effectiveness
❌ Caffeine – Increases nervousness & restlessness
❌ MAO Inhibitors (Antidepressants) – Can cause dangerous high BP

🩺 Nursing Considerations

✔ Limit use to 3-5 days (to avoid rebound congestion)
✔ Monitor blood pressure & heart rate (especially for heart patients)
✔ Educate patients to avoid caffeine & certain meds

🔹 Key Point: Short-term use only! Overuse = worse congestion + high BP risk 🚫👃📈

Page 10: Clinical Judgment for Nasal Decongestants

Concept: Gas Exchange

• Nasal decongestants help open airways by reducing swelling

• Monitor breathing & circulation in at-risk patients

🔎 Recognizing Cues (Assessment)

✔ Check for history of high blood pressure (hypertension)
✔ Assess breathing difficulties & oxygen levels

🩺 Analyzing Cues & Prioritizing Hypothesis

• Risk: Hypoxemia (low oxygen levels)

• Main Issue: Decreased gas exchange due to congestion

✅ Generating Solutions (Goals)

✔ Patient’s cough will be reduced or eliminated
✔ Improved breathing & oxygenation

🔹 Key Point: Nasal decongestants improve airflow, but BP & oxygen levels must be monitored! 👃💨📈.

Page 11: Action Plan for Nasal Decongestants

Taking Action (Nursing Interventions)

✔ Monitor vital signs (VS) – Watch for increased BP & heart rate
✔ Check bronchial secretions – Yellow/green = possible infection
✔ Teach proper nasal spray use – Avoid spraying directly at the septum
✔ Limit use to 3 days – Prevent rebound congestion
✔ Advise reading OTC labels – Many products contain decongestants
✔ Encourage fluid intake – Helps thin mucus
✔ Educate on hand hygiene – Cold & flu spread through hand-to-hand contact

📊 Evaluating Outcomes

✅ Patient breathes easier with reduced congestion
✅ No nonproductive cough
✅ No signs of rebound congestion or side effects

🔹 Key Point: Short-term nasal decongestant use + good hygiene = better respiratory health! 👃💨👐

Page 12: Intranasal Glucocorticoids

What Are Intranasal Glucocorticoids?

• Steroid-based nasal sprays that reduce inflammation in nasal passages

• Used for allergic rhinitis, nasal congestion, and sinusitis

💊 Common Intranasal Glucocorticoids

✔ Fluticasone (Flonase)
✔ Budesonide (Rhinocort)
✔ Mometasone (Nasonex)

⚠ Side Effects

🤕 Headache
👃 Nasal irritation (dryness, burning)
💢 Sore throat

🩺 Nursing Considerations

✔ Teach proper use – Spray away from the nasal septum
✔ Use daily for best results (not just when symptoms appear)
✔ Monitor for nosebleeds & irritation

🔹 Key Point: Glucocorticoid nasal sprays reduce inflammation but require daily use! 👃💨

Page 13: Expectorants and Antitussives

Expectorants

• Function: Loosen bronchial secretions (e.g., Guaifenesin).

• Side Effects: Drowsiness, nausea.

Antitussives

• Purpose: Suppress cough reflex (e.g., dextromethorphan).

• Types: Nonopioid and opioid.

Page 14: Acute Pharyngitis Treatment

Sinusitis Treatment

✔ Decongestants – Reduce nasal swelling & improve drainage
✔ Acetaminophen – Relieves sinus pain & fever
✔ Fluids & Rest – Helps clear sinuses & speeds recovery
✔ Antibiotics – Only for severe or bacterial cases

🩺 Acute Pharyngitis Treatment

✔ Antibiotics – Only if bacterial (e.g., strep throat)
✔ Saline gargles – Soothes throat irritation
✔ Lozenges – Provides temporary relief
✔ Fluids & Rest – Helps recovery
✔ Acetaminophen – For pain & fever

🔹 Key Point: Most cases don’t need antibiotics! Focus on symptom relief & hydration. 💧

Page 15:

Question:
A patient is receiving an expectorant. What symptom indicates to the nurse that the drug is exerting its therapeutic effect?

A. Bronchodilation
B. Decreased coughing
C. Loosening of bronchial secretions
D. Relief of nasal congestion

✅ Correct Answer: C. Loosening of bronchial secretions

Why?

• Expectorants help thin and loosen mucus so it can be coughed out more easily.

• They don’t directly stop coughing (they make it more productive).

• They don’t cause bronchodilation (that’s what bronchodilators do).

• They don’t relieve nasal congestion (that’s what decongestants do).

🔹 Key Point: Expectorants = More productive cough by loosening mucus! 💨👃

Page 16:

Question:
A nurse is teaching an older adult patient about guaifenesin. Which information is appropriate to include in this teaching? (Select all that apply.)

A. Take the drug with a glass of water.
B. Read labels on over-the-counter drugs and check with HCP before taking cold remedies.
C. Take the drug at bedtime. (Incorrect – Best taken during the day to help clear mucus)
D. Advise patient to contact health care provider if cough persists more than 2 days.

✅ Correct Answers: A, B, D

✔ A: Fluids help thin mucus, making the expectorant more effective.
✔ B: Many OTC cold meds contain guaifenesin + other drugs—check for interactions.
❌ C: Taking it at bedtime may increase coughing at night due to loosened mucus.
✔ D: If cough lasts more than 2 days, it could indicate a more serious issue.

🔹 Key Point: Stay hydrated, check OTC meds, and seek help if symptoms persist! 💧👃💨

Page 17:

A patient has been diagnosed with the common cold. Which drug should the nurse question if it is ordered to treat this patient?

A. Antihistamines
B. Antitussives
C. Expectorants
✅ D. Antibiotics

✅ Correct Answer: D. Antibiotics

Why?

• The common cold is caused by a virus, and antibiotics only treat bacterial infections 🦠❌

• Antihistamines, antitussives, and expectorants can help manage symptoms, but antibiotics should NOT be given unless a secondary bacterial infection is present.

🔹 Key Point: Colds = Viral ❌ No antibiotics! Treat symptoms instead. 🤧💊

Page 18:

Recommended Duration

• When teaching a patient about the use of nasal decongestant sprays, the nurse informs the patient that they are most effective and less likely to lead to rebound congestion when administered for how many days?

  A. 3 days
  B. 10 days
  C. 14 days
  D. 20 days

  ---

  ✅ Correct Answer: A. 3 days

  Why?

  • Nasal decongestants (like oxymetazoline & phenylephrine) shrink nasal blood vessels to relieve congestion.

  • Using them for more than 3 days can cause rebound congestion (worse congestion when the drug is stopped).

  • Patients should limit use to 3 days and switch to other treatments if needed.

  🔹 Key Point: Use nasal sprays for max 3 days to avoid worsening congestion! 👃🚫

Page 19

Question:
Which of the following history is most important for the nurse to assess before administering diphenhydramine?

A. Allergy to penicillin. (Not related to diphenhydramine use)
B. Hypertension. (Not a major concern, though antihistamines can cause slight BP changes)
C. Diabetes mellitus type 2. (Not a contraindication)
D. Closed-angle glaucoma. (Most important!)

✅ Correct Answer: D. Closed-angle glaucoma

Why?

• Diphenhydramine has anticholinergic effects → Increases intraocular pressure (IOP)

• Can worsen or trigger a glaucoma attack 🚨

• Contraindicated in closed-angle glaucoma patients

🔹 Key Point: Always assess for glaucoma before giving diphenhydramine! 👁🚫