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Respiratory System
Chapter 43
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Respiration
Process of air exchange
Oxygen is obtained and carbon dioxide is
eliminated
Gas exchange occurs in the alveoli
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Four parts of respiration
Ventilationmovement of air between the
atmosphere and alveoli
Perfusionblood flow through the lungs
Diffusionoxygen and carbon dioxide are
transferred between alveoli and blood
Regulationrespiratory muscles and nervous
system
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Respiratory Tract
Nose, pharynx, larynx, trachea, bronchi
Series of tubes that function as airway
passages
Filter, warm and humidify incoming air
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Pharynx
Contain the tonsilsnormal function is to
fight infection
Larynxvoice box
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Epiglottis
Flexible cartilagesupported flap that covers
the opening of the trachea or (glottis).
It automatically closes the opening to the
trachea during swallowing.
If you eat food to fast it can get lodged in the
trachea.
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Heimlich Maneuver
Used to pop food out and back into the
pharynx.
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Heimlich Maneuver - Infant
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Trachea
Trachea is lined with ciliated columnar
epithelium and mucous cells.
The chronic cough of smokers is caused by
damage to cilia.
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Cilia - Smokers
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Lungs
Right side has 3 lobes
Left side 2 lobes
Contains the lower respiratory structures
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Bronchi
Definition: The bronchi are small air
passages, composed of hyaline cartilage,
that extend from the trachea to the
bronchioles. There are two bronchi in thehuman body that branch off from the trachea.
The bronchi are lined with mucous
membranes that secrete mucus and cilia that
sweep the mucus and particles up and out of
the airways.
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Alveoli
Have a very thin membrane that allows rapid
diffusion of oxygen and carbon dioxide
between capillary blood and alveolar air
spaces. Lined with surfactant to prevent alveolar
collapse.
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Surfactant
Essential fluid that lines the alveoli and
smallest bronchioles.
Reduces surface tension of the lung allowing
the oxygen and carbon dioxide across themembrane.
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Lack of Surfactant
Premature infants can have Respiratory
Distress Syndrome due to immaturity of
lungs.
Persons with Chronic Obstructive PulmonaryDisease (COPD).
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Nervous System Role
Nervous system regulates the rate and depth
of respirations.
Medulla oblongata is the respiratory control
system of the brain.
Cough reflex is stimulated by nervous
system.
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Disorders of Respiratory System
Infections: bronchiolitis or pneumonia
Allergic disorders
Inflammatory disorders
Obstructive airway disorders Bronchial pulmonary dysplasiapremature
infants
Asthma
Chronic obstructive pulmonary diseases (COPD)
Injury to lungs
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Drugs for Asthma and
Broncho-constrictive Disorders
Chapter 44
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Asthma
Airway disorder characterized by
Hyper-reactivity to various stimuli - trigger
Broncho-constriction
Inflammation
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Clinical Manifestations - Asthma
Dyspneadifficulty breathing
Wheezing
Chest tightness
Coughchronic cough may be the only
symptom
Sputum production
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Precipitating Factors - Triggers
Viral infectionsespecially with infants and
young children
Allergies
GERDGastro Esophageal Reflux Disease
Cigarette smoke
Smoggy airsmoke from fires
Windy weatherhot and dry Santa Ana
winds
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Pathophysiology
Acute reaction to some triggerreversible
with treatment
Mast cells release substances that cause
inflammation and constriction
Broncho-constriction or bronchospasm
Spasm aggravated by inflammation, mucosal
edema and excessive mucus.
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Quick Relief
Short-acting, inhaled, beta 2 agonist, 2-5
puffs as needed.
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Albuterol, levalbuterol, Proventil
Classification Pharmacologic: adrenergic
Classification Therapeutic: bronchodilator
Action: binds to beta2 adrenergic receptors in
airway smooth muscle. Decreased
intracellular calcium relaxes smooth muscle
airways. Relaxation of airway smooth muscle
with subsequent bronchodilation. Relativelyselective for beta 2 (pulmonary) receptors.
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Beta 2 Agonist
Side effects: nervousness, restlessness,
tremor, chest pain and palpitations.
Nursing implications:
Assess lung sounds, pulse and blood pressure.
Monitor pulmonary function tests.
Observe for bronchospasmlisten for wheezing.
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Beta2 Agonist
Rescue drugshort acting beta2- adrenergic
agonist used for prevention and treatment of
bronchocontriction.
Onset 15 to 30 minutes Peak 60 to 90 minutes
Duration 3-6 hours
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How Provided
Provided in extended-release tablet
Albuterol syrup
Nebulizer or dry powder inhaler
Often used in exercise induced asthma
Take 15 minutes before exercise
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Albuterol INH - Nebulizer
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Directions for use of inhaler
Shake well
Exhale (breathe out) through your nose whilekeeping mouth shut
Close lips around mouth piece Take slow, deep breath through the
mouthpiece as you press down on containerto release the medication
Hold breath for 5-10 seconds
Exhale slowly
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Teaching
May give up to 3 treatments at 20 minute
intervals
If no relief need to call PMD or go to ED
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Long Term Control
Mild-intermittent
Symptoms 2 days/week or less
Treat acute exacerbations with
Beta 2 agonist
Short course of systemic corticosteroid
prednisone.
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Moderate Persistent Asthma
Daily symptoms
Inhaled corticosteroids
Long-acting beta 2 agonist
Leukotriene or theophylline
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Corticosteroids
Long term control of asthma
Inhaled by Nebulizer or metered dose inhaler
For an infant hold the Nebulizer with a firm fitting
mask to the infant or small childs face Metered dosehave client rinse and spit after
dose to avoid developing thrush
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Action of Corticosteroids
Suppress inflammation in the airways by
inhibiting
Movement of fluid and protein into tissues
Migration and function of neutrophils andeosinophilsWBCs
Synthesis of histamine in mast cells
Production of pro-inflammatory substances
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Uses
Severe asthmaused when multiple doses
of inhaled beta2 agonists are not beneficial
POprednisone
IVmethyl prednisone
In chronic asthmainhaled
COPDnot as effective as the acute /
chronic asthma
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When to call MD or go to ED
Tight chestwheezingdifficulty breathing
Symptoms not relieved by home meds.
3 treatments with short-acting beta 2 agonist
such as albuterol with no relief.
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Emergency Treatment
Epinephrine IV or Sub Q
For life threatening asthma when inhaled
short acting beta 2 drugs have been tried
either prior to coming to the ED or in the ED.
IV corticosteroidsmethyl prednisone or
Solu-medrol.
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Epinephrine 1 to 10,000 or 0.1 mg/mL
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Epinephrine 1:1000 - 1 mg/mL
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Methylprednisone
Adult dosing: 40 to 250 mg every 4 to 6 hours
Pediatric dosing: 2 mg / kg / dose in asthma.
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Diagnostics
History
Peak expiratory flow measurements: used to
document severity as well as to serve as a
baseline to measure improvement. Pulse Oximetry
WBC: eosinophils will be elevated if allergy
Arterial blood gas
Chest x-ray
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Peak Flow Meter
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Hyper-inflated Lungs in Asthma
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COPD - Chronic Bronchitis
COPDmore of a chronic disease due to
long-term exposure to airway irritants such as
smoking.
Broncho-constriction and inflammation aremore constant and less reversible.
Changes have occurred over the years.
Blue Bloaters they are often cyanotic.
h
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COPD - Emphysema
Loss of elasticity of the lung tissue
Destruction of structures supporting the
alveoli and capillaries feeding the alveoli
Air trapping at the alveolar level
Pink Puffers hyperventilate to maintain
adequate oxygen levelsthis prevents
hypoxia
COPD
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COPD
E h
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Emphysema
COPD Cli i l M if i
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COPD - Clinical Manifestations
Dyspneadifficulty breathing
Activity intolerance
Cough and sputum production
Progressive
Mild COPD
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Mild COPD
Short acting beta 2 agonist
Cessation of smoking
Immunization against flu
M d COPD
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Moderate COPD
Add one or more long-acting bronchodilators
such as salmeterol
Inhaled Anticholinergic drugs such as
Atrovent PO Theophylline
S l l
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Salmeterol
Brand name: Serevent
Classification Pharmacologic: adrenergic
Classification Therapeutic: bronchodilator
Action: Produces accumulation of cyclic
adenosine monophosphate (cAMP) at the
beta 2-adrenergic receptors.
Use with caution: Cardiovascular disease,diabetes, glaucoma
S l l S
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SalmeterolSerevent
Indication: long-term control of reversible
airway obstruction due to asthma and for
maintenance treatment of asthma.
Onset in 10 to 25 minutes Peak in 3-4 hours
Duration 12 hours
I i A
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Ipratropium or Atrovent
Therapeutic classification: allergy, cold andcough remedies, bronchodilators
Pharmacologic classification: anticholinergic
Action: inhibits cholinergic receptors inbronchial smooth muscle, resulting indecreased levels of cGMP.
Therapeutic effects: bronchodilates without
system anticholinergic effects. Side effects: hypotension
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X hi h h lli
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Xanthines - theophylline
Brand name: Accurbron, Theo-dur, Apo-Theo
Classification Pharmacologic: xanthines
Classification Therapeutic: bronchodilators
Action: Inhibits phosphodiesterase, producingincreased tissue concentrations of cAMP. Increased
levels of cAMP result in bronchodilation, CNS
stimulation, diuresis.
Indication: Long-term control of reversible airwayobstruction caused by asthma or COPD.
X thi Th h lli
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Xanthines - Theophylline
Theophyllinemechanism of action unknown
Used in COPD and sometimes asthma
Inhibits pulmonary edema by decreasing vascular
permeability Increases ability of cilia to clear mucus
Strengthens contractions of diaphragm
Mild diuretic
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L k t i M difi
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Leukotriene Modifiers
Newest class of drugs to treat asthma
Block the production of leukotrienes and
subsequently prevent inflammation
Drugs in this class Singulairchewable tabs taken once a day in the
evening.
Accolatetake twice daily one hour before or twohours after meal.
Montelukast
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Montelukast
Brand name: Singulair
Classification Pharmacologic: leukotriene antagonist
Classification Therapeutic: allergy, cold, and cough,
bronchodilators Action: Antagonizes the effects of leukotrienes,
which mediate the following: airway edema, smooth
muscle constriction, altered cellular activity. Results
in decreased inflammatory process which is part ofasthma and allergic rhinitis.
M st C ll St biliz r
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Mast Cell Stabilizer
Cromolyn
Prevent the release of broncho-constrictive
and inflammatory substances when mast
cells are confronted with allergens and otherstimuli
Inhaled drug
Nasal form available for allergic rhinitis
To icity of Dr gs
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Toxicity of Drugs
Bronchodilators
Theophylline
Bronchodilator Overdose
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Bronchodilator Overdose
Excessive cardiac and CNS stimulation
Angina, tachycardia and palpitations
Agitation, anxiety, insomnia, seizures and
tremors
Theophylline Overdose
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Theophylline Overdose
Anorexia, nausea, vomiting, agitation,nervousness, insomnia, tachycardia, and
convulsions
Need to check serum drug levels Not use as frequently as in the past
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Antihistamines and AllergicDisorders
Chapter 45
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Action
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Action
Contraction of smooth muscle in the bronchiand bronchioles
Stimulation of vagus nervecough reflex
Increases permeability of veins andcapillaries
Increase secretion of mucous glands
Dilation of capillaries of skincausesflushing
Types of Allergic Reactions
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Types of Allergic Reactions
Type IIgE or atophyhay fever, skininflammation, food allergies, asthma
Type IImediated by IgG or IgMinternal
harder to diagnoses and treat Type IIIantigen-antibody complex
Type IVoccurs several hours after
exposureTB test
Allergic Rhinitis
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Allergic Rhinitis
Inflammation of nasal mucosa caused byType I hypersensitivity.
Two types
Seasonal Perineal or chronic
Allergic Dermatitis
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Allergic Dermatitis
Type IV by direct contact with antigens whichperson has come in contact with
Poison Ivy, cosmetics, hair dyes, metals,
drugs etc Urticariavascular reaction of skin
characterized by papules or wheals and
severe itching
Urticaria
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Urticaria
Allergic Drug Reactions
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Allergic Drug Reactions
Immunologic response
Follows ingestion of a drug
May occur from 7 to 10 days after drug
therapy
May not occur the first time drug
administered
Can occur minutes or hours afteradministration
Anaphylaxis Life-threatening allergy
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AnaphylaxisLife-threatening allergy
Serious and rapid allergic reaction
Can happen from food and nuts
Antibioticspenicillin
Dyes injected into the body in special tests
NSAIDs
Latexgloves, balloons, catheters
Bees or wasps
Anaphylaxis Symptoms
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Anaphylaxis Symptoms
Urticaria, hives
Low blood pressurefainting
Swelling in throatangioedema
Asthma symptomsbronchocontriction
Tingling in lips and mouth
Death occurs with obstruction to breathing
and low blood pressure
Emergency Treatment
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Emergency Treatment
Adrenalineepinephrine
Dose for adult 0.3 mg
Dose for child 0.15 mg
After dose given must get client to the
hospital for more definitive treatment.
Antihistamines
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Antihistamines
Antihistamines block the effects of histamineat the H1 receptor. They do not block
histamine release, antibody production or
antigen-antibody reactions. Mostantihistamines have anticholinergic properties
and may cause constipation, dry eyes, dry
mouth and blurred vision. I addition, many
antihistamines cause sedation.
Use with Caution
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Use with Caution
Elderly
Pyloric obstructions
Hyperthyoidism
Cardiovascular disease
Liver disease
Use with caution in pregnancy
Uses
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Uses
Allergic rhinitis
Anaphylaxis
Allergic conjunctivitis
Drug allergies
Blood transfusion reactions
Dermatologic conditions
H1 receptor antagonists
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H1 receptor antagonists
First generation
Non-selective or sedating
CNS depression
Benadryl
diphenhydramine
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diphenhydramine
Brand name: Benadryl
Classification Pharmacologic: H1 antagonist
Classification Therapeutic: allergy, cold and
cough remedies, antihistamines, antitussive.
Action: Antagonizes the effects of histamine
at H1 receptor sites; does not bind to or
inactivate histamine. Significant CNSdepressant and anticholinergic properties.
Benadryl
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Benadryl
High incidence of drowsiness Well absorbed after oral administration
Acts within 15 minutes and lasts for 8 to 12
hours Available in combination drugs
Decongestants
Analgesics
Allergy
Cold remedies
Hydroxyzine
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Hydroxyzine
Brand name: Atarax, Vistaril
Classification Pharmacologic: CNS
depressant
Classification Therapeutic: Anti-anxiety,antihistamine, sedative, hypnotic
Action: Acts as a CNS depressant at the
subcortical level of the CNS. Hasanticholinergic, antihistamine, and antiemetic
properties.
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Nasal Decongestant, Antitussiveand Cold Remedies
Chapter 46
Common Cold
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Common Cold
Viral infection of upper respiratory tract
Adults have two to four colds per year
Children can have up to ten a year
Management of common cold
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Management of common cold
Symptoms: cough, runny nose, blocked nose,sore throat, fever, malaise, headache, loss of
appetite.
No antibiotics unless super-imposed bacterialinfectionotitis media (ear infection)
No drug therapy to cure or shorten duration
of URI. No benefit of using anti-histamines
Cold Remedies
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Co d e ed es
Antihistamines : Allegra, Benadryl, Claritin,Clarinex, Zyrtec
Decongestants: cause constriction of swollen
blood vessels in nose, sinuses and chest Sudafedmost often used in combination
Cetirizine
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Brand name: Zyrtec Classification Pharmacologic: piperzine
Classification Therapeutic: Allergy, cold and
cough remedies, antihistamine Action: Antagonizes the effects of histamine
at H1 receptor sites; does not bind to orinactivate histamine. Anticholinergic effects
are minimal and sedation is dose related. Does not make client sleepy.
Cough
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g
Coughing is a protective reflex especiallywhen secretions are copious.
Most coughs due to viral illnesscommon
cold.
Cough Remedies
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g
Centrally acting cough suppressants -antitussives
Antihistamines
Soothing remedies (syrup or lozenges) Expectorants
Mucolytic
Oral hydration
Mist therapy
Antitussive Drugs
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g
Cough Suppressants
Suppress cough by depressing the cough
center of the medulla oblongata or cough
receptors in the throat Indication: dry, hacking, nonproductive cough
that interferes with rest or sleep
Example: cough syrups with codeine
Expectorants
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p
Agents generally given orally to liquefy respiratorysecretions and allow for their easier removal.
Generic name: gualifenesin
Brand name: Robitussin
Classification Therapeutic: allergy, cold and cough
remedies, expectorants
Action: reduces viscosity of tenacious secretions by
increasing respiratory tract fluid.
Anti-histamines
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H1-receptor inhibitors
Anti-allergy
Added to cough and cold remedies as both
antitussives and to treat the nasalcongestion.
Do not have any direct antitussive effect but
may act indirectly by reducing postnasal drip.
Demulcents
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Liquid that coats the throat and soothesirritated mucous membranes.
May reduce coughing associated with a dry
throat. Some cough syrups contain 40% alcohol
may have a sedating effect.
Inexpensive Do not over use
Mucolytic Drugs
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y g
Designed to alter the viscosity of bronchialsecretions, thereby making them easier to
clear by cough or ciliary transport.
Often used when client reports they feel likethey have mucous by cant cough it up.
Mucomyst only agent used inhalant.
Clinical pearl: mucomyst used inacetaminophen or Tylenol overdose
Nasal Sprays
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p y
Nose sprays: decongestant for directapplication to nares
Has bounce back effectdo not use for more
than three days