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Allergy and Respiratory Medications Copyright © 2016 by Mosby, an imprint of Elsevier Inc. Respiratory System Upper Respiratory System Oral and nasal cavity, sinuses, pharynx, larynx, and trachea Lower Respiratory System Right and left bronchi, right and left lungs, bronchioles, and alveoli Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 2 Antihistamines Two types: Histamine H1-receptor antagonists and histamine H2 antagonists First-generation or second-generation drugs are further divided into six main groups 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 GI system Sedative effect on the CNS Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 3 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 Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 4 Antihistamines (cont.) Side Effects Constipation, blurred vision, dry mouth, urinary retention, dried thickened secretions Adverse Reactions Tachycardia, confusion, dizziness, insomnia, nausea Restlessness, excitability, sedation, tinnitus, dysuria, impotence, photosensitivity Drug Interactions Nursing Process Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 5 Antihistamines (cont.) Lifespan considerations Pediatrics: 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 (light-headedness and fainting), confusion and extrapyramidal reactions Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 6 Antitussives Actions: 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 Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 7 Antitussives (cont.) Adverse Reactions Drowsiness, dry mouth, nausea, postural hypotension Drug Interactions Nursing Process Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 8 Asthma Medications Overview Asthma is a condition that involves increased inflammation, swelling, and mucus production that lead to bronchiolar constriction. The person is able to breathe air into the lungs but has difficulty breathing out. Wheezing results because the person works to force air out through narrowed, mucus-filled passages during expiration. The four classes of asthma severity include mild intermittent, mild persistent, moderate persistent, and severe persistent. Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 9 Asthma Medications (cont.) COPD is a chronic, disabling disorder that causes destruction of alveolar walls. This destruction creates unequal areas of ventilation and perfusion in the body, and oxygen and carbon dioxide exchange is impaired. Patients experience difficulty in expiration. Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 10 Asthma Prophylaxis Medications Prophylactic treatment Cromolyn sodium Nedocromil sodium Actions: Works at the surface of the mast cell as a mast cell stabilizer to prevent the release of histamine, leukotrienes, and slow-reacting substances of anaphylaxis. Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 11 Bronchodilators Sympathomimetics Relax smooth muscle of bronchi (dilate) Vasoconstriction of blood vessels in body (decreases mucosal and submucosal edema) Increase the rate and force of heart contraction Uses: Relief of symptoms of bronchospasm in acute or chronic asthma, bronchitis, and COPD Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 12 Bronchodilators (cont.) Anticholinergics Block cholinergic receptors in the airways of the lung causing decreased contractility of smooth muscle. Uses: Manage respiratory symptoms of cough, difficulty breathing, and mucous production. Primarily used in the treatment of COPD. Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 13 Bronchodilators (cont.) Xanthines Relax smooth muscle in the bronchi and blood vessels in the lungs Directly act on the kidney to produce an increase in urine production CNS effects Uses Adjunctive therapy for bronchospasm in acute and chronic bronchial asthma, bronchitis, emphysema Treatment of neonatal apnea Acute pulmonary edema Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 14 Leukotriene Receptor Inhibitors Montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo CR) Reduce symptoms of asthma by blocking receptors for cysteinyl leukotrienes C4, D4, and E4 Uses Treat acute or chronic asthma in patients unable to take inhaled glucocorticoids Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 15 Corticosteroids Block reaction to allergens and reduce airway hyperresponsiveness Inhibit cytokine production, protein activation, and inflammatory cell migration and activation Uses Inhaled, long-term asthma control Systemic; often used to get quick control of the disease when beginning long-term therapy or to speed recovery from severe episodes Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 16 Decongestants Directly affect alpha receptors of blood vessels in the nasal mucosa, causing vasoconstriction Uses: Relieve nasal congestion from allergies and upper respiratory infections Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 17 Expectorants Decrease the thickness of respiratory secretions, which facilitates expectoration Uses: Treat productive cough, assist with thick mucus Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 18 Topical Intranasal Steroids Action Antiinflammatory, reduce nasal congestion Uses Treatment of allergic, mechanical, or chemically induced local nasal inflammation or nasal polyps when usual treatment has failed to work Adverse reactions Asthma, headache, lightheadedness, loss of sense of smell, nasal irritation and dryness, nausea, nosebleeds, perforation of nasal septum, altered sense of taste and smell Copyright © 2016 by Mosby, an imprint of Elsevier Inc. 19