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Chapter 40 Drugs for Upper Respiratory Disorders Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Upper Respiratory Disorders Upper respiratory infections Common cold • Etiology: rhinovirus • Affects nasopharyngeal tract Acute rhinitis • Inflammation of nasal mucous membranes Sinusitis • Inflammation of mucous membranes of sinuses Acute pharyngitis • Inflammation of throat Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Upper Respiratory Disorders (Cont.) Contagious period of common cold Transmission 1 to 4 days before onset of symptoms During first 3 days of cold Touching contaminated surfaces, then touching nose or mouth Viral droplets from sneezing Symptoms of common cold Nasal congestion, nasal discharge, cough, increased mucosal secretions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Antihistamines H1-blockers (H1 blockers or H1 antagonists) can cause drowsiness, dizziness, fatigue, and disturbed coordination First-generation antihistamines • Diphenhydramine (Benadryl) Second-generation antihistamines Nonsedating antihistamines • Cetirizine (Zyrtec) • Fexofenadine (Allegra) • Loratadine (Claritin) • Azelastine (Astelin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Antihistamines (Cont.) Diphenhydramine (Benadryl) Action • Competes with histamine for receptor sites preventing a histamine response • Reduces nasopharyngeal secretions, itching, sneezing Use • Treats acute and allergic rhinitis, antitussive Contraindications/cautions • Severe liver disease, narrow-angle glaucoma, urinary retention Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Antihistamines (Cont.) Diphenhydramine (Benadryl) Administration: oral, IM, IV Interactions • Increases CNS depression with alcohol and other CNS depressants • Avoid use of MAOIs Side effects • Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dyscrasias Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Nursing Process: Diphenhydramine (Benadryl) Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Nursing Process: Diphenhydramine (Benadryl) (Cont.) Diphenhydramine (Benadryl) Nursing interventions • Obtain list of environmental exposures, drugs, recent • • • • foods eaten, stressors. Give with food to decrease GI distress. Avoid operating motor vehicles if drowsiness occurs. Avoid alcohol and other CNS depressants. Use sugarless candy or gum or ice chips for temporary relief of mouth dryness. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Second-Generation Antihistamines Nonsedating antihistamines Fewer anticholinergic symptoms Cetirizine (Zyrtec) Cexofenadine (Allegra) Loratadine (Claritin) Azelastine (Astelin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Nasal Congestion Nasal congestion Dilation of nasal blood vessels • Due to infection, inflammation, allergy Transudation of fluid into tissue spaces • Leads to swelling nasal cavity Nasal decongestants: Systemic decongestants Stimulate alpha-adrenergic receptors • Produces nasal vascular vasoconstriction • Shrinks nasal mucous membranes • Reduces nasal secretion • Rebound nasal congestion Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Nasal Congestion (Cont.) Systemic decongestants Used primarily for allergic rhinitis, including hay fever and acute coryza • Ephedrine (Ephedrine), • Phenylephrine (Neo-Synephrine) • Pseudoephedrine (Sudafed) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Nasal Decongestants (Cont.) Ephedrine HCl (Primatene) Naphazoline HCl (Privine) Oxymetazoline (Afrin) Phenylephrine HCl (Neo-Synephrine Nasal) Pseudoephedrine (Sudafed) Tetrahydrozoline (Tyzine) Administration Nasal spray, nasal drops, tablet, capsule, liquid Interactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Nasal Decongestants (Cont.) Side effects Nervousness, restlessness, “jitters” Alpha-adrenergic effect (hypertension, hyperglycemia) Frequent use May lead to tolerance May lead to rebound nasal congestion Should not use more than 5 days Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Intranasal Glucocorticoids Beclomethasone (Beconase, Vancenase, Vanceril) Budesonide (Pulmicort, Rhinocort) Dexamethasone (Decadron) Flunisolide Fluticasone (Flonase, Flovent) Triamcinolone (Nasacort) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Intranasal Glucocorticoids (Cont.) Action Antiinflammatory Use Treat allergic rhinitis May be used alone or in combination with H1 antihistamines Dexamethasone should not be used longer than 30 days to avoid systemic effects. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Expectorants Guaifenesin (Robitussin) Action • Loosens bronchial secretions by reducing surface tension of secretions Use • Dry, nonproductive cough Side effects • Drowsiness, nausea Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Antitussives Act on the cough-control center in the medulla to suppress the cough reflex Three types of antitussives are nonnarcotic, narcotic, or combination preparations. Dextromethorphan (Benylin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Nursing Process: Common Cold Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Sinusitis and Pharyngitis Sinusitis Treatment • Decongestant, acetaminophen, fluids, rest, antibiotics Acute pharyngitis Treatment • Saline gargles, lozenges, increased fluid intake, acetaminophen • Antibiotics with bacterial infection Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Practice Question #1 A patient is receiving dextromethorphan (Benylin). The nurse knows the drug is exerting its therapeutic effect when the patient experiences A. B. C. D. thinning of secretions. bronchodilation. decreased coughing. relief of nasal congestion. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Practice Question #2 The nurse is teaching an older adult patient about guaifenesin (Robitussin). 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 health care provider before taking cold remedies. C. Take the drug at bedtime. D. Advise patient to contact health care provider if cough persists more than 2 days. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Practice Question #3 A patient has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat this patient? A. B. C. D. Antihistamines Antitussives Expectorants Antibiotics Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Practice Question #4 Which medication is a first-generation antihistamine? A. B. C. D. Cetirizine (Zyrtec) Fexofenadine (Allegra) Diphenhydramine (Benadryl) Loratadine (Claritin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Practice Question #5 When teaching a patient about use of nasal decongestant sprays, the nurse informs the patient that they are most effective when administered for how many days? A. B. C. D. 4 days 10 days 14 days 20 days Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Practice Question #6 Before administering diphenhydramine (Benadryl) to a patient, it is most important for the nurse to assess the patient for a history of A. B. C. D. allergy to penicillin. hypertension. diabetes mellitus type 2. narrow-angle glaucoma. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Practice Question #7 Which statement about dextromethorphan does the nurse identify as being true? A. B. C. D. It is a narcotic antitussive. It suppresses the cough center of the medulla. It suppresses respirations. It causes physical dependence. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26