Ppt chapter 54

Drugs Acting on the Upper Respiratory Tract

Chapter 54

Drugs Used to Treat Upper Respiratory Infections

• Antitussives

– Block the cough reflex

• Decongestants

– Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions

• Antihistamines

– Block the release or action of histamine that increases secretions and narrows airways

Drugs Used to Treat Upper Respiratory Infections (cont.)

• Expectorants

– Increase productive cough to clear airways

• Mucolytics

– Increase or liquefy respiratory secretions to aid clearing of airways

Sites of Action of Drugs Working on the Upper Respiratory Tract

AntitussivesAntitussives

• Actions

– Act directly on the medullary cough center of the brain to depress the cough reflex

• Indications

– Control nonproductive cough

• Pharmacokinetics

– Rapidly absorbed, metabolized in the liver, and excreted in the urine

• Contraindications

– Patients who need to cough to maintain the airway

– Head injury or impaired CNS

Antitussives (cont.)Antitussives (cont.)

• Caution

– Hypersensitivity or history of narcotic addiction

• Adverse Effects

– Drying effect on the mucous membranes

– CNS adverse effects

– GI upset

Topical Nasal DecongestantsTopical Nasal Decongestants• Actions

– Sympathomimetic

– Affects sympathetic nervous system to cause vasodilatation

– Causing less inflammation of the nasal membrane

• Indications

– Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis

Topical Nasal Decongestants (cont.)Topical Nasal Decongestants (cont.)

– Generally not absorbed systemically

– Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted in the urine

– Lesion or erosion in the mucous membranes

• Caution

– Any condition that might be exacerbated by sympathetic activity

Topical Nasal Decongestants (cont.)Topical Nasal Decongestants (cont.)

• Adverse Effects

– Local stinging and burning

– Rebound congestion

– Sympathomimetic effects

• Drug-to-Drug Interactions

– Cyclopropane or halothane

QuestionQuestion

Please answer the following statement as true or false.

Antitussive agents should be used with caution in patients who have a history of addiction.

AnswerAnswer

Rationale: Caution should also be used in patients who are hypersensitive to or have a history of addiction to

narcotics (codeine, hydrocodone).

Oral DecongestantsOral Decongestants

• Actions

– Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes

• Indications

– Promotion of drainage in the sinuses and improving air flow

– Well absorbed, widely distributed in the body

– Metabolized in the liver and primarily excreted in urine

Oral Decongestants (cont.)Oral Decongestants (cont.)

– Any condition that might be exacerbated by sympathetic activity

• Adverse Effects

– Rebound congestion

– Sympathetic effects

– OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects

Topical Nasal Steroid DecongestantsTopical Nasal Steroid Decongestants

• Actions

– Exact mechanism of action is not known

• Indications

– Seasonal allergic rhinitis

– Inflammation after the removal of nasal polyps

– Generally not absorbed systemically

Topical Nasal Steroid Decongestants (cont.)

– Acute infection

• Caution

– Active infection

– Avoid exposure to airborne infections

• Adverse Effects

– Local burning, irritation, stinging, dryness of the mucosa, and headache

– Suppression of healing can occur in a patient who has had nasal surgery or trauma

AntihistaminesAntihistamines• Actions

– Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response

– Anticholinergic and antipruritic effects

• Indications

– Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema

– Well absorbed, metabolized in the liver, excreted in urine and feces

– Pregnancy and lactation

Antihistamines (cont.)Antihistamines (cont.)

• Caution

– Renal or hepatic impairment

– History of arrhythmias

• Adverse Effects

– Drowsiness and sedation

– Anticholinergic effects

– Vary based on the drug

ExpectorantsExpectorants

• Actions

– Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions

– Indications

– Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough

– Rapidly absorbed, metabolism and excretion has not been reported

Expectorants (cont.) Expectorants (cont.)

• Adverse Effects

– GI symptoms

– Headache

– Dizziness

– Mild rash

– Prolonged use may result in masking a serious underlying disorder

QuestionQuestion

Which of the following is an adverse reaction to topical nasal steroids?

A. Increased nasal drainage

B. Rebound effect

C. Suppression of healing

D. Local ulceration

AnswerAnswer

C. Suppression of healing

Rationale: Adverse Effects: local burning, irritation, stinging, dryness of the mucosa, and headache; suppression of healing can occur in a patient who has had nasal surgery or trauma.

MucolyticsMucolytics• Actions

– Work to break down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions

• Indications

– Patients who have difficulty coughing up secretions

– Patients who develop atelectasis

– Patients undergoing diagnostic bronchoscopy

– Postoperative patients

– Patients with tracheostomies

Mucolytics (cont.)Mucolytics (cont.)• Pharmacokinetics

– Nebulization or direct instillation into the trachea

• Caution

– Acute bronchospasm, peptic ulcer, and esophageal varicies

• Adverse Effects

– GI upset

– Stomatitis and/or rhinorrhea

– Bronchospasm

– Rash

Use of Upper Respiratory Tract Agents Across the Lifespan

Prototype AntitussivesPrototype Antitussives

Prototype Topical Nasal Decongestants Prototype Topical Nasal Decongestants

Prototype Topical Nasal Steroid Decongestants

Prototype AntihistaminesPrototype Antihistamines

Prototype ExpectorantsPrototype Expectorants

Prototype Mucolytics Prototype Mucolytics

QuestionQuestion

What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus?

A. Guaifenesin

B. Flunisolide

C. Acetylcysteine

D. Dextromethorphan

AnswerAnswer

C. Acetylcysteine

Rationale: Actions: Enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus.

Nursing Considerations for Antitussives Nursing Considerations for Antitussives

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation

Nursing Considerations for Topical Nasal Decongestants

• Implementation

• Evaluation

Nursing Considerations for Oral Decongestants

• Implementation

• Evaluation

Nursing Considerations for Topical Nasal Steroid Decongestants

• Implementation

• Evaluation

Nursing Considerations for AntihistaminesNursing Considerations for Antihistamines

• Implementation

• Evaluation

Nursing Considerations for Expectorants Nursing Considerations for Expectorants

• Implementation

• Evaluation

Nursing Considerations for MucolyticsNursing Considerations for Mucolytics

• Implementation

• Evaluation

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