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Allergy and Respiratory Medications

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Presentation on theme: "Allergy and Respiratory Medications"— Presentation transcript:

1 Allergy and Respiratory Medications
Chapter 11 Allergy and Respiratory Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1

2 Learning Objectives Identify major antihistamines used to treat breathing problems Describe the action of antitussive medications List medications used to treat and prevent asthma attacks Describe the major actions and the adverse reactions of the two main categories of bronchodilators Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

3 Types of AntiHistamines
ALKYLAMINES bromopheniramine (Dimetapp) chlorpheniramine (Chlo-Trimeton) ETHANOLAMINES diphenhydramine (Benadryl) PHENOTHIAZINE promethazine (Phenergan) PIPERIDINES cetirizine (Zyrtec) fexofenadine (Allegra) lorantidine (Claritin) PIPERAZINE hydroxyzine (Vistaril) MISCELLANEOUS azelastine (Astelin) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

4 Antihistamines (cont.)
Uses Seasonal allergic rhinitis (SAR) Perennial allergic rhinitis (PAR) Perennial nonallergic rhinitis (PNAR) Relieve symptoms of allergic disorders Adjunctive therapy for anaphylaxis Sedation Allergic rhinitis is a condition in which a person has a reaction to outdoor allergens (SAR) or indoor allergens (PAR). Perennial nonallergic rhinitis (PNAR) is a condition in which inflammatory symptoms are caused by problems other than allergens. Histamine plays a role in producing the inflammatory symptoms in these conditions: watery eyes, nasal stuffiness, postnasal drip, and sneezing. Antihistamines are used for hives, angioneurotic edema, serum sickness, and blood-product reactions and are a common ingredient in cold remedies because they decrease mucus secretion and cause drowsiness at bedtime. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

5 Antihistamines Action
Compete with histamine for H1 receptor sites to limit its effectiveness Limits vasodilation, capillary permeability, and swelling Limits acetylcholine release, which dries secretions in the bronchioles and gastrointestinal system Sedative effect on the CNS Histamine is released (by mast cells and basophils) when the body is injured. Histamine dilates the capillaries of the smooth muscle and vascular system. Antihistamines relieve the effects of histamine on body organs and structures. The six major groups of antihistamines are found in Table These groups vary in characteristics and action. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

6 Antihistamines (cont.)
Adverse Reactions Changes in blood pressure, blurred vision Tachycardia, insomnia, dry mouth, nausea Restlessness, excitability, sedation, tinnitus Drug Interactions Nursing Process Some patients might experience CNS overstimulation and others CNS sedation from antihypertensives. Antihistamine overdosage is potentially fatal, particularly in children, because the CNS is stimulated and depressed at the same time. What drugs increase the effect of antihistamines? (CNS depressants such as hypnotics, sedatives, tranquilizers, depressant analgesics, alcohol) Antihypertensives strengthen the action of other drugs such as anticholinergics and may mask ototoxicity from drug therapy. These medications also can interfere with the effect of anticholinesterase drugs and may decrease the effect of corticosteroids and hormones. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

7 Antihistamines Life span considerations Pediatrics: Elderly
Infants and young children often have anticholinergic side/adverse effects Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability Elderly More likely to develop side effects such as dizziness, syncope (fainting), confusion, and extrapyramidal reactions Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

8 Question 1 Which of the following is NOT an adverse reaction that may develop from taking antihistamines? Hypertension Hypotension Tachycardia Bradycardia Correct Answer: 4 Rationale: Some of the adverse reactions that may develop in the patient receiving antihistamines include hypertension (high blood pressure), hypotension (low blood pressure), tachycardia (rapid heartbeat), blurred vision, confusion, dizziness, drowsiness, excitation, insomnia (inability to sleep), paradoxical excitation (when a patient shows stimulation rather than the usual sedation), restlessness, sedation, tinnitus (ringing in the ears), anorexia (lack of appetite), constipation, diarrhea, dry mouth, nausea, vomiting, difficult or painful urination, impotence, urinary retention or frequency, photosensitivity (abnormal response to exposure to sunlight), rash, urticaria (itching), nasal congestion, and thickening of bronchial secretions because of direct mucosal drying. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

9 Types of Antitussives Narcotic Non-Narcotic codeine phosphate
codeine sulfate Non-Narcotic dextromethorphan Robitussin Vick’s Formula 44 diphenhydramine Benadryl Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

10 Antitussives Actions: Uses: Depress the cough center in the brain
Anesthetize stretch receptors in the respiratory tract Soothe irritated areas in the throat Uses: Relief of overactive or nonproductive cough Antitussives have central, peripheral, and local nervous system effects in the body. Antitussives are commonly combined with other drugs and are usually sold as OTC drugs. Antitussives with codeine are typically sold as prescription drugs. Antitussives with codeine depress the cough center in the brain. Antitussives without codeine act only peripherally and locally in the body. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

11 Antitussives (cont.) Adverse Reactions Drug Interactions
Constipation, drowsiness, dry mouth, nausea, postural hypotension Drug Interactions Nursing Process Antitussives have an additive effect with other CNS depressants and increase the analgesic effect of aspirin. In reviewing the nursing process, what assessments should a nurse make before administering an antitussive with codeine? What nursing diagnoses could be made? What planning should be done? Implementation? What should the nurse evaluate to verify medication effectiveness? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

12 ASTHMA PREVENTION INTAL (cromolyn sodium)
Action: slows destruction of mast cell which releases the histamine resulting in decreased histamine circulation ONLY for prophylaxis NOT A RESCUE MEDICATION Must be inhaled on a set schedule Symptoms improve within 4 weeks See MD at weeks 2 & 4 Do not stop drug abruptly

13 Types of Asthma Bronchodilators
Sympathomimetic (Rescue Drugs) Proventil / Ventolin (albuterol***) Adrenalin Chloride (epinephrine) Isuprel (isoproterenol) Alupent (metaproterenol) Serevent (salmeterol) Brethine (terbutaline) Xanthine (-phylline) Aminophylline Slo-Phyllin (theophylline) *** albuterol has less cardiac side effects & longer bronchodilation than remainder of drugs listed

14 Action of Bronchodilators
Open the airway by stimulating Beta 2 receptors Some drugs have greater effects on Beta 1 (heart) than others Sympathomimetic drugs mimic epinephrine stimulation as side effects Tachycardia and insomnia are frequently seen.

15 Additional Asthma meds
Leukotriene receptor inhibitors (for chronic use); decreases the interleukine release from the injured tissues. NOT a rescue medication Singulair (montelukast) Accolate (zafirlukast)

16 Corticosteroid Use for Asthma/ COPD
Systemic methylprednisolone prednisolone prednisone Inhaled Beclovent (beclomethasone) Pulmicort (cortisone for pulmonary tract) (budesonide) Aerobid (flunisolide) Flovent (fluticasone propionate) Azmacort (triamcinolone acetonide)

17 Intranasal Steroids (Sprays)
Beconase (beclomethasone dipropionate) Rhinocort Aqua (Budesonide) Aerobid (flunisolide) Flonase (fluticasone propionate) Nasonex (mometasone furoate) Nasocort AQ (triamcinolone acetonide) Many are the same as inhaler medications but reformulated for spray application Effects are topical unless swallowed

18 Actions of Corticosteroid Usage
‘… the most potent and consistently effective medication for long term control of asthma.” Anti-inflammatory; decrease reaction to allergens Systemic steroids are used to get quick control of the airway then inhaled steroids will be used to maintain the effect. Inhaled drugs have a local effect; better for long term use RINSE the mouth after steroid inhalation to prevent thrush

19 Remember: COME -TAPE- FIGS
C = Cataracts O = Osteoporosis M = Mood changes E = Elevated blood sugar T = Thin skin A = Addison’s disease P = Peptic ulcers E = Electrolyte imbalance F = Fluid retention I = Increased risk of infection G = Gain Weight S = Short stature (if taken as a child)

20 Decongestants Affect alpha cells in blood vessels in nose tissue = vasoconstriction, decreased fluid movement and edema. Prolonged use can lead to rebound vasodilation causing more congestion. Used for congestion in nose, middle ear and Eustachian tube. Decreasing congestion around the auditory tube allows the middle ear to better drain NOT to be used in infants and toddlers Systemic decongestants work better than topical but also have more side effects than topical drugs.

21 Nasal Decongestants Sympathomimetic bronchodilators Inhalers
ephdrine Epinephrine * * denotes drug used by MDs on a daily basis Inhalers Afrin / Dristan (oxymetazoline) Neo-Synephrine (phenylephrine) Sudafed (pseudoephedrine sulfate)

22 Expectorants Decrease the thickness of the mucus (by increasing the water content) in the respiratory tract to aid in the ability to remove it. Increases ciliary movement so cough is effective. Anti- tuss/ Robitussin/ Mucinex (guaifenesin) Used often; may increase bleeding tendency. Monitor for bruising or bleeding especially if taking anticoagulants SSKI (iodine products) – use infrequently

23 Practice A 29 year old male comes to the ED with c/o SOB, wheezing and chest pain when he coughs. 1. What assessments do you perform? 2. What lab tests should be ordered? 3. Would you start an IV (assume orders are present)? What kind? Why? 4. What medications would the nurse anticipate being ordered? 5. What patient teaching should be considered?


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