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Respiratory Agents I. II. Purpose Antihistamines a. Drug profiles Non-sedating Astemizole (Hismanal) Loratadine (Claritin) Fexofenadine (Allegra) Cetirizine (Zyrtec) Sedating Diphenhydramine (Benadryl) Dimenhydrinate (Dramamine) Promethazine (Phenergan) Hydroxyzine (Vistaril) Meclizine (Antivert) Doxlylamine (Unisom) Brompheniramine (Dimetane) Chlorpheniramine (Chlor-Trimeton) b. MOA i. Blocks H1 receptors preventing histamine from binding and causing:_________________________ __________________________________________ c. Uses i. Allergies, allergic reactions, allergic rhinitis ii. Parkinson’s disease iii. Vertigo, motion sickness, nausea iv. Sleep aid v. Common cold d. Side effects i. Drowsiness, visual changes ii. Paradoxical excitement in children iii. Anticholinergic:_____________________________ e. Nursing Considerations i. Take with food ii. Use hard candy or chewing gum to relieve dry mouth iii. fluids and fiber iv. Do not take with alcohol v. Do not take with any other OTC medication unless OK with MD vi. Do not use with erythromycin or antifungals d/t life threatening CV disorders vii. Use cautiously in patients with COPD, PUD, HTN, asthma, increased intraocular pressure, seizures, BPH, or pregnancy B. Decongestants a. Drug profiles i. Naphazoline (Privine) ii. iii. iv. v. vi. b. MOA i. Phenylephrine (Neo-Synephrine) Phenylpropanolamine Pseudoephedrine (Sudafed) Ephedrine (Vicks Vatronol) Oxymetazoline (Afrin, Sinex) Stimulate engorged blood vessels in the sinuses to constrict decreasing pressure and allowing mucous membranes to drain; most are sympathomimetic drugs which stimulate alpha1 receptors c. Uses i. Rhinitis, allergies, sinusitis, colds d. Side effects i. Rebound congestion ii. Anxiety, nervousness iii. Palpitations, hypertension e. Nursing Considerations i. Do not take at HS ii. Do not take with MAOIs iii. Topical decongestants risk of systemic effects C. Antitussive a. Drug profiles i. Opioid 1. Codeine 2. Hydrocodone ii. Non-opioid 1. Dextromethorphan (Vicks Formula 44, Robitussin DM) 2. Benzonatate (Tessalon Perles) b. MOA i. Blocks the cough reflex 2o to direct action on the cough center. ii. Tessalon:____________________________________________________ ______________________________________________________ c. Uses i. Dry, hacking non-productive cough d. Side effects i. Opioid: respiratory depression, drowsiness e. Nursing Considerations i. No fluid or food for 30 min. after cough syrup ii. Avoid with asthma, COPD, and severe pneumonia D. Expectorants a. Drug profiles i. Guaifenesin (Guiatuss, Robitussin, Mucinex) ii. Terpin Hydrate iii. Ammonium Chloride b. MOA i. Increase the flow of fluid in the respiratory tract, decrease viscosity and facilitates removal of secretion through cough and ciliary action; irritate the GI tract causing reflex stimulation of resp. tract. c. Uses i. Productive cough d. Side effects e. Nursing Considerations i. Only expectorant recognized by FDA as safe and effective ii. Has faint odor and bitter taste. iii. Force fluids to help liquefy secretions. E. Mucolytics a. Drug profiles i. Acetylcysteine (Mycomyst) ii. Hypertonic saline b. MOA c. Uses i. Thick, tenacious secretions d. Side effects i. Bronchospasms ii. Nausea e. Nursing Considerations i. Mycomyst is administered via nebulizer treatment ii. Have patient clear airway first iii. Smells like rotten eggs F. Bronchodilators a. Xanthine derivatives i. Drug profiles 1. Theophylline (Bronkodyl, Slo-Bid, Theo-Dur) 2. Aminophylline (Theophylline admin. IV) ii. MOA 1. Causes bronchodilaton by cAMP. Competes to block phosphodiesterase (PDE), which breaks down cAMP. 2. Inhibits___________Builds up____________ Causes __________________ iii. Uses 1. COPD, asthma, chronic bronchitis, emphysema 2. Pneumonia 3. Cystic fibrosis 4. Increase ease of breathing iv. Side effects 1. GI: N/V, anorexia, GERD 2. CV: tachycardia, palpitations, ventricular dysrhythmias 3. GU: U/O v. Nursing Considerations 1. Aminophylline is given to patients who have not responded to fastacting beta-agonists 2. Therapeutic level: 8-20 b. Beta agonists i. Drug profiles 1. Albuterol (Proventil)—Beta2 2. Epinephrine (Adrenalin)—Alpha/Beta 3. Isoproterenol (Isuprel)—Beta1&2 Short-acting 4. Metaproterenol (Alupent)—Beta1&2 5. Terbutaline (Brethine)—Beta2 6. Salmeterol (Serevent)—Beta2 Long-acting 7. Salbuterol (Salbuvent)—Beta2 ii. MOA 1. Imitate the effect of norepinephrine on alpha and beta-receptors. Bronchodilation occurs when _____ is stimulated. iii. Uses 1. Acute asthma attacks 2. Anaphylaxis or other serious allergic reactions iv. Side effects 1. CNS: nervousness, tremors 2. CV: tachycardia, HTN v. Nursing Considerations 1. Contraindicated in heart disease, dysrhythmias, HTN, seizures 2. Salmeterol, salbuterol, metaproterenol are all long-acting bronchodilators c. Anticholinergic i. Drug profiles (-tropium) 1. Ipratropium (Atrovent) 2. Tiotropium (Spiriva) 3. Combivent (Albuterol and Atrovent) ii. MOA 1. Blocks PSNS and causes bronchodilation of larger airways iii. Uses 1. Asthma iv. Side effects 1. Nervousness, tremors, dry mouth, palpitations v. Nursing Considerations 1. Contraindicated in BPH and glaucoma 2. Teach patient how to use metered dose inhaler (MDI) 3. Not for acute asthma attacks G. Anti-inflammatory a. Antileukotrienes i. Drug profiles 1. Zileuton (Zoflo) 2. Zafirlukast (Accolate) 3. Montelukast (Singulair) ii. MOA 1. Blocks leukotrienes from attaching to receptors located on circulating cells as well as cells within the lungs, blocks inflammation and reduces edema iii. Uses 1. Asthma, allergies iv. Side effects v. Nursing Considerations 1. Contraindicated in patients with hepatic dysfunction b. Corticosteroid i. Drug profiles 1. Prednisone 2. Flunisolide (AeroBid) 3. Dexamethasone (Decadron) 4. Budesonide (Rhinocort) 5. Fluticasone (Flonase) 6. Triamcinolone (Azmacort) 7. Beclomethasone (Beclovent, Vanceril) ii. MOA 1. Stabilizes the cell membrane inhibiting release of histamine and SRS-A release iii. Uses iv. Side effects 1. Adrenocortical insufficiency 2. susceptibility to infection 3. F & E imbalances 4. Endocrine: blood glucose 5. Dermatological: 6. CNS: v. Nursing Considerations 1. NEVER stop drug abruptly c. Indirect acting anti-asthmatics i. Drug profiles 1. Cromolyn (Nasalcrom, Intal, Opticrom) 2. Nedocromil (Tilade) ii. MOA 1. Stabilize the cell membrane and prevent release of harmful substances iii. Uses 1. Prevent asthma attacks iv. Side effects 1. Coughing, sore throat, rhinitis, bronchospasms, taste changes, dizziness, and HA v. Nursing Considerations 1. May take up to 4 weeks to work 2. Used for prevention not rescue treatment