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DRUGS FOR RESPIRATORY DISORDERS Upper Common cold Inflammation of nasal mucous membranes Sinusitis Etiology: rhinovirus Affects nasopharyngeal tract Acute rhinitis respiratory infections Inflammation of mucous membranes of sinuses Acute pharyngitis Inflammation of throat Contagious period of common cold 1 to 4 days before onset of symptoms During first 3 days of cold Transmission Touching contaminated surfaces, then touching nose or mouth Viral droplets from sneezing Symptoms of common cold Nasal congestion, nasal discharge, increased mucosal secretions cough, H1-blockers (antagonists) First-generation antihistamines Diphenhydramine (Benadryl) Second-generation antihistamines Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin) Nonsedating antihistamines; little to no effect on sedation 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 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 Diphenhydramine (Benadryl) (cont’d) 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. Second-generation antihistamines Differences Reduced sedation Fewer anticholinergic effects Dry mouth, blurred vision, wheezing, urinary retention May be taken with a moderate amount of alcohol, but this is not recommended. 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 Stimulate alpha-adrenergic receptors Produces nasal vascular vasoconstriction Shrinks nasal mucous membranes Reduces nasal secretion Oxymetazoline (Afrin) nasal spray Pseudoephedrine (Sudafed) Administration Nasal spray, nasal drops, tablet, capsule, liquid Interactions Sudafed may decrease effect of beta blockers May increase blood pressure, dysrhythmias with MAOIs May increase restlessness, palpitations with caffeine (e.g., coffee, tea) Oxymetazoline (Afrin), naphazoline (Allerest), pseudoephedrine (Sudafed) Side effects Frequent use Nervousness, restlessness, “jitters” Alpha-adrenergic effect (hypertension, hyperglycemia) May lead to tolerance May lead to rebound nasal congestion Should not use more than 5 days Fluticasone (Flonase) Triamcinolone (Nasacort) 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. Guaifenesin and codeine (Cheratussin) Action Suppress cough reflex by acting on cough center in the medulla Reduce viscosity of tenacious secretions Use Nonproductive, irritating cough Side effects Drowsiness, dizziness, nausea Guaifenesin (Robitussin; Mucinex) Action Loosens bronchial secretions by reducing surface tension of secretions Use Dry, nonproductive cough Side effects Drowsiness, nausea Sinusitis Treatment Decongestant, acetaminophen, fluids, rest, antibiotics Acute pharyngitis Treatment Saline gargles, lozenges, increased fluid intake, acetaminophen Antibiotics with bacterial infection Pathophysiologic changes Airway obstruction with increased airway resistance to airflow Major disorders Chronic bronchitis Emphysema Asthma Etiology Cigarette smoking, inflammation Chronic lung infections Allergens Characteristic symptoms Dyspnea, excess mucus secretions Airway obstruction, bronchospasm Permanent, irreversible damage to the lung tissue Signs and Symptoms of Chronic Obstructive Pulmonary Disease (COPD) Conditions Factors Contributing to Bronchoconstriction Pathophysiologic Decrease in total changes lung capacity from: Fluid accumulation Loss of elasticity of the lung tissues Etiology Pulmonary fibrosis Pneumonitis Lung tumors Thoracic deformities Myasthenia gravis (scoliosis) Anticholinergics Albuterol (Proventil, ProAir) Ipratropium bromide (Atrovent) Ipratropium (Combivent) Action: dilates bronchioles Administration: aerosol inhaler Caution Narrow-angle glaucoma Methylxanthine (Xanthine) derivatives Aminophylline (Somophyllin), theophylline (SloBid) Action: relaxes smooth muscle of bronchi, bronchioles increasing cAMP, promoting bronchodilation Use: maintenance therapy for chronic stable asthma Therapeutic range: 10 to 20 mcg/mL (toxicity greater than 20) Aminophylline (Somophyllin), theophylline (SloBid) Contraindications: seizure, cardiac, renal, or liver disorders Administration: oral, IV Side effects: dysrhythmias, nervousness, irritability, insomnia, flushing, dizziness, hypotension, seizures, GI distress, intestinal bleeding, hyperglycemia, tachycardia, palpitations, cardiorespiratory collapse Zafirlukast (Accolate), montelukast (Singulair) Action: reduce inflammatory process and decrease bronchoconstriction Use: prophylactic and maintenance for chronic asthma Side effects: dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis Glucocorticoids Beclomethasone (Beclovent, Vanceril), dexamethasone (Decadron), solumedrol, solucortef Action: antiinflammatory effect Administration Aerosol inhaler: fluticasone, beclomethasone – used in long acting inhalers (budesonide/formoterol fumarate dihydrate; fluticasone propionate and salmeterol; Tablet: dexamethasone, prednisone, medrol dose pack Injection: dexamethasone (Decadron), solumedrol, solucortef Aerosol inhaler Metered-dose inhaler (MDI) Dry powdered inhaler (DPI) Frequent dosing Tremors, nervousness, tachycardia Administration Teach client to use inhaler correctly and take care of equipment correctly. Acetylcysteine Action Administer 5 minutes after a bronchodilator Should not be mixed with other drugs Also an antidote for acetaminophen overdose if within 12 to 24 hours Liquefies and loosens thick mucus secretions Administration (Mucomyst) Give orally diluted in juice or soft drink Also used to treat acetaminophen toxicity Etiology Mycobacterium tuberculosis Acid-fast bacillus Transmission Person to person via droplets Coughing, sneezing Clients at risk Alcohol addicted, debilitated Immunocompromised Homeless Poverty stricken populations Symptoms Cough, sputum Fever, night sweats, weight loss GI distress Prophylaxis recommended (6 months to 1 year) Close contact with diagnosed TB client HIV positive with positive TB test Converted from negative to positive TB test Contraindicated in liver disease Drug combinations Single-drug therapy Ineffective Multidrug therapy Decreases bacterial resistance to drug Treatment duration decreased Drug selection First-line drugs Isoniazid, rifampin,ethambutol Treatment Divided regimen into 2 phases Phase 1 Duration: 2 months Phase 2 Duration: 4 to 7 month May use Direct Observation Therapy Isoniazid (INH) Route: Oral, IM Inhibits bacterial cell wall synthesis Side effects/adverse reactions GI distress, constipation Blurred vision, photosensitivity Tinnitus, dizziness Peripheral neuropathy Psychotic behavior, seizures Blood dyscrasias, hepatotoxicity Isoniazid (INH) (cont’d) Drug interaction Increases effect of INH Alcohol, rifampin, cycloserine, phenytoin Decreases phenytoin effect when concurrent Decreases absorption Antacids Alcohol Increases risk of neuropathy, hepatotoxicity Isoniazid (INH) (cont’d) Client teaching Take INH 1 hour before meals or 2 hours after meals Must follow complete regimen Collect sputum specimen in early morning Take pyridoxine (vitamin B6) to prevent peripheral neuropathy Check liver enzymes, CBC Need frequent eye examinations Report numbness, tingling, burning Teach sun precautions, to avoid antacids Rifampin Warn client that body fluids may be red-orange Ethambutol Take single daily dose to avoid visual disturbances Action Inhibit bacterial synthesis Bacteriostatic Fights gram – bacteria of folic acid Proteus, Klebsiella, E. coli, Chlamydia Uses Otitis media, respiratory infections UTIs, prostatitis, gonorrhea Route Oral, IV, topical, ophthalmic Types of sulfonamides Intermediate-acting Trimethoprim-sulfamethoxazole (Bactrim) Sulfasalazine (Azulfidine) Side effects/adverse reactions GI distress, stomatitis, photosensitivity Crystalluria, renal failure Blood dyscrasias, Stevens-Johnson syndrome Nursing interventions Increase fluid intake to at least 2000 Monitor CBC and renal function. Monitor for rash, superinfection. Avoid during third trimester. Avoid antacids. mL/day. Trimethoprim Interferes with bacterial folic Urinary tract antiinfective Effective against gram – Proteus, Klebsiella, E. coli acid synthesis TMP/SMZ Bactrim, Septra Blocks bacterial protein synthesis Bactericidal effect Treats UTI, otitis media, bronchitis, burns Route Oral, IV pneumonia, TMP/SMZ (cont’d) Drug interaction Warfarin Increases anticoagulation Oral hypoglycemic Increases hypoglycemia TMP/SMZ (cont’d) Side effects Mild to moderate rash, photosensitivity GI distress, stomatitis, crystalluria Fatigue, depression, headache, dizziness Adverse reactions Blood dyscrasias Stevens-Johnson syndrome Renal failure TMP/SMZ Nursing interventions Administer with full glass of water 1 hour before meals or 2 hours after meals. Increase fluid intake. Monitor for sore throat, bruising, bleeding. Monitor CBC. Check for superinfection. Advise client not to take with antacids. Tell client to avoid direct sunlight. Fungal infections Treats superficial infections Skin, mucous membranes Mild Systemic infections Lungs, CNS Severe Antifungal Polyenes drug groups Nystatin Azoles Fluconazole (Diflucan), miconazole (Monistat) Nystatin (Mycostatin) Methods of administration: Action oral, topical Increases permeability of fungal cell membrane Fungistatic, fungicidal Client teaching Administration: Swish and swallow Gargle if throat affected Azoles Fluconazole Treat (Diflucan) Candidiasis, cryptococcosis, histoplasmosis Route oral, IV, vaginal, topical