Presentation on theme: "Common Conditions of the Upper Respiratory System"— Presentation transcript:
1 Introduction to Clinical Pharmacology Chapter 31 Upper Respiratory System Drugs
2 Common Conditions of the Upper Respiratory System InfectionsAllergic rhinitisCoughsCommon coldCongestion
3 Medication ClassesIntranasal steroids or antihistamines relieve allergy symptomsDecongestants reduce nasal edemaAntitussives, mucolytics, and expectorants treat accompanying cough
4 Intranasal Steroids USES AND ACTIONS Intranasal steroids (INS) AKA nasal glucocorticoidsfirst-line treatment for symptoms of allergic rhinitisused to treat rhinitis caused by nonallergens, nasal polyps, and chronic sinusitis.administered topically, the result occurs locally and produces minimal systemic adverse reactions.ADVERSE REACTIONSinclude an unpleasant smell or tasteDrying of the nasal passages resulting in irritation and nose bleeds (epistaxis)Fungal infections (Candida albicans) of the nares are a rare reaction.
5 Intranasal Steroids CONTRAINDICATIONS AND PRECAUTIONS Those hypersensitive to steroids should not take INS.INS are pregnancy category C and should be used only when the benefit outweighs the risk to the fetus.INS are used cautiously in patients taking systemic steroids.Some studies suggest there may be a slowing in growth rate of children using these products for extended periodsINTERACTIONSWhen cimetidine (used to reduce stomach acid) is taken with budesonide, the INS is less effective.
6 HistamineHistamine is produced in response to an allergic reaction or tissue injury.The release of histamine produces an inflammatory response.Dilation of small arterioles results in localized redness. An increase in the permeability of small blood vessels promotes an escape of fluid from these blood vessels into the surrounding tissues, which produces localized swelling.Histamine is also released from mast cells in allergic reactions or hypersensitivity reactions, such as anaphylactic shock.
7 Antihistamines: Actions Antihistamines block most, but not all, of the effects of histamineFirst-generation antihistamines bind nonselectively to central and peripheral H1 receptors and may result in CNS stimulation or depression( sedating)Other first-generation drugs may have additional effects: antipruritic (anti-itching) or antiemetic (antinausea) effectsSecond-generation antihistamines are selective for peripheral H1 receptors and, as a group, are less sedating
8 Antihistamines: Uses Seasonal and perennial allergies Allergic and vasomotor rhinitisAllergic conjunctivitisMild and uncomplicated angioneurotic edema and urticariaAllergic reactions to drugs, blood, or plasmaCoughs caused by colds or allergy
9 Antihistamines: Uses (cont.) Adjunctive therapy in anaphylactic shockTreatment of parkinsonismRelief of nausea and vomitingRelief of motion sicknessSedationAdjuncts to analgesics
10 Antihistamines: Adverse Reactions Central nervous system reactionsDrowsiness or sedation; disturbed coordinationAnticholinergic effects (cholinergic blocking)Dryness of mouth, nose, and throat; thickening of bronchial secretionsSecond-generation preparations (e.g., loratadine) cause less drowsiness and fewer anticholinergic effects than some of the other antihistamines.
11 Antihistamines: Contraindications and Precautions Contraindicated during pregnancy and lactationFirst-generation antihistamines:patients with known hypersensitivity to the drugs,newborns, premature infants, nursing mothers,individuals undergoing monoamine oxidase therapy,and in patients with angle-closure glaucoma,stenosing peptic ulcer,symptomatic prostatic hypertrophy,and bladder neck obstruction
12 Antihistamines: Contraindications and Precautions (cont.) Second-generation antihistamines: patients with known hypersensitivityCetirizine is contraindicated in patients who are hypersensitive to hydroxyzineUsed with caution in patients with bronchial asthma, cardiovascular disease, narrow-angle glaucoma, symptomatic prostatic hypertrophy, hypertension, impaired kidney function, peptic ulcer, urinary retention, pyloroduodenal obstruction, and hyperthyroidism
13 Antihistamines: Interactions Interactant drugEffect of InteractionRifampinMay reduce the absorption of antihistamine, fexofenadine, for exampleMonamine oxidase inhibitorsIncrease in anticholinergic and sedative effects of antihistamineCNS depressantsPossible additive CNS depressant effectBeta blockersRisk for increased cardiovascular effects, with diphenhydramine, for exampleAluminum- or magnesium-based antacidsDecreased concentrations of antihistamine in blood, fexofenadine, for example
14 Decongestants: Actions and Uses Nasal decongestants: sympathomimetic drugs,works directly on blood vessels to reduce swelling of the nasal passages, which, in turn, opens clogged nasal passages and enhances drainage of the sinuses.Uses:Used to treat the congestion associated with the following conditions:Common cold; hay fever; sinusitis; allergic rhinitis; congestion associated with rhinitis
15 Decongestants: Adverse Reactions and Contraindications When used topically in prescribed doses, there are usually minimal systemic effects in most individuals.On occasion, nasal burning, stinging, and dryness may be seen.Use of oral decongestants may result in the following adverse reactions:Tachycardia and other cardiac arrhythmias; nervousness; restlessness; insomnia; blurred vision; nausea; vomiting
16 Decongestants: Adverse Reactions and Contraindications Contradicted:In patients with known hypersensitivity and patients taking monoamine oxidase inhibitorsSustained-released pseudoephedrine is contraindicated in children younger than 12 years of age
17 Decongestants: Precautions Decongestants are used cautiously in patients with:Thyroid disease; diabetes mellitus; cardiovascular disease; prostatic hypertrophy; coronary artery disease; peripheral vascular disease; hypertension; glaucomaPregnant women should consult with their primary health care provider before using these drugs
18 Decongestants: Interactions Interactant drugEffect of interactionMAOIsSevere headache, hypertension, and possibly hypertensive crisisBeta-adrenergic blocking drugsInitial hypertension episode followed by bradycardia
19 Antitussives, Expectorants, and Mucolytics: Actions and Uses Coughing is the forceful expulsion of air from the lungs.A nonproductive cough is a dry, hacking one that produces no secretions. An antitussive drug is used to relieve coughing.With a productive cough, secretions are made in the respiratory tract. An expectorant is a drug that thins respiratory secretions to remove them more easily from the respiratory system.A mucolytic is a drug that breaks down thick, tenacious mucus in the lower portions of the lungs for better elimination from the respiratory system.
20 Antitussives, Expectorants, and Mucolytics: Adverse Reactions LightheadednessDizzinessDrowsiness or sedation
21 Antitussives, Expectorants, and Mucolytics: PRECAUTIONSAntitussives are given with caution to patients with a persistent or chronic cough or a cough accompanied by excessive secretions, a high fever, rash, persistent headache, and nausea or vomiting.Antitussives containing codeine are used with caution during pregnancy (pregnancy category C, in patients with COPD, acute asthmatic attack, pre-existing respiratory disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hepatic or renal impairment, and prostatic hypertrophy.Expectorants are used cautiously during pregnancy and lactation; in patients with persistent cough, severe respiratory insufficiency, or asthma; and in older adults or debilitated patients.
22 Nursing Process: Assessment Preadministration assessment:The assessments the nurse may perform:Assess the involved areas (eyes, nose, and upper and lower respiratory tract) if the patient is receiving an antihistamine for the relief of allergy symptomsIf promethazine (Phenergan) is used with an opioid to enhance the effects and reduce the dosage of the opioid, take the patient’s blood pressure, pulse, and respiratory rate before giving the drug
23 Nursing Process: Assessment (cont.) Ongoing assessment:Observe the patient for the expected effects of the antihistamine and for adverse reactionsAntihistamine is given for a serious situation: assess the patient at frequent intervals until the symptoms appear relieved and for about 24 hours after the incident
24 Nursing Process: Assessment Preadministration assessment:Assess the patient’s blood pressure, pulse, and congestion before administering the decongestants; assess the lung sounds and bronchial secretions, and note in the patient’s records; obtain the history of the use of the productsOngoing assessment:Assess the patient’s blood pressure, pulse, and congestion; question the patient about attaining therapeutic effects and presence of adverse reactions
25 Nursing Process: Diagnoses Risk for Injury related to drowsiness, dizziness, or sedationIneffective Airway Clearance related to pooling of or thick secretionsImpaired Oral Mucous Membranes related to dry mouth, nose, and throat
26 Nursing Process: Planning The expected outcomes for the patient depend on the reason for administration of the antihistamine but may include:Optimal response to therapySupporting of patient needs related to managing adverse reactionsUnderstanding of and compliance with the prescribed treatment regimen
27 Nursing Process: Planning Expected outcomes for the patients include:Optimal response to therapySupport of patient needs related to the management of adverse reactionsUnderstanding of and compliance with the prescribed treatment regimen
28 Nursing Process: Implementation (cont.) Monitoring and managing patient needs:Impaired oral mucous membranes:Dryness of the mouth, nose, and throat: Offer the patient frequent sips of water or ice chips to relieve the symptomsRisk of injury:Assist the patient with ambulationPlace the call light within easy reach and instruct to call before attempting to get out of bed and ambulating
29 Nursing Process: Implementation Loratadine or other rapidly disintegrating tablets can be administered with or without water and are placed on the tongue, where the tablet dissolves almost instantly.Fexofenadine is not administered within 2 hours of an antacid.Chewing benzonatate tablets may result in a local anesthetic effect (oropharyngeal anesthesia) with possible choking as a result.Acetylcysteine has a distinctive, disagreeable odor. The medication may smell like “rotten eggs.” Although this odor may be nauseating, the smell dissipates quickly.
30 Nursing Process: Implementation Promoting an optimal response to therapyIneffective breathing pattern:Overuse of topical form: “Rebound” nasal congestionPatient is taught to take the drug exactly as prescribed or discontinue the drug therapy gradually
31 Nursing Process: Implementation (cont.) Educating the patient and family:Review the dosage regimen and possible adverse drug reactions with the patient
32 Nursing Process: Implementation (cont.) Educating the patient and family: The nurse should include the following points in the teaching plan:Use this product as directed by the primary health care provider or on the container labelUnderstand that overuse of topical nasal decongestants can make the symptoms worse, causing rebound congestionIf using a spray, do not allow the tip of the container to touch the nasal mucosa and do not share the container with anyone
33 Nursing Process: Evaluation Mucous membranes are moist and intactNo injury is reportedThe patient and family understand the drug regimen
34 Nursing Process: Evaluation (cont.) The patient maintains effective breathing patternThe therapeutic effect is achievedThe patient demonstrates an understanding of and compliance with the drug regimen
35 Question Is the following statement true or false? Cough, cold, congestion, and allergies are common problems in the upper respiratory system.
36 AnswerTrueCough, cold, congestion, and allergies are common problems in the upper respiratory system.
37 Question Is the following statement true or false? Expectorants or mucolytics are used to reduce inflammation.
38 AnswerFalseAntihistamines are used to reduce inflammation; decongestants reduce edema and swelling; antitussives are used to eliminate cough. When congestion produces secretions in either the respiratory passages or the lungs, expectorants or mucolytics are used, respectively.